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Top Drugs 1 > Skeletal Muscle Relaxants and Antimigraine Agents > Flashcards

Skeletal Muscle Relaxants and Antimigraine Agents Flashcards

1
Q

Baclofen

A

Lioresal, Ozobax

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2
Q

Carisoprodol

A

Soma, Vanadom

C-IV

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3
Q

Cyclobenzaprine

A

Flexeril

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4
Q

Metaxalone

A

Skelexin

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5
Q

Methocarbamol

A

Robaxin

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6
Q

Tizanidine

A

Zanaflex

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7
Q

Eletriptan

A

Relpax

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8
Q

Rizatriptan

A

Maxalt

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9
Q

Sumatriptan

A

Imitrex

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10
Q

Therapeutic Class - Baclofen

A

Centrally acting skeletal muscle relaxant

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11
Q

Therapeutic Class - Carisoprodol

A

Centrally acting skeletal muscle relaxant

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12
Q

Therapeutic Class - Cyclobenzaprine

A

Centrally acting skeletal muscle relaxant

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13
Q

Therapeutic Class - Metaxalone

A

Centrally acting skeletal muscle relaxant

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14
Q

Therapeutic Class - Methocarbamol

A

Centrally acting skeletal muscle relaxant

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15
Q

Therapeutic Class - Tizanidine

A

Centrally acting skeletal muscle relaxant

Alpha-2 agonist

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16
Q

Therapeutic Class - Eletriptan

A

Antimigraine serotonin receptor agonist

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17
Q

Therapeutic Class - Rizatriptan

A

Antimigraine serotonin receptor agonist

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18
Q

Therapeutic Class - Sumatriptan

A

Antimigraine serotonin receptor agonist

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19
Q

Dosage Forms - Baclofen

A

Tablet: 5 mg, 10 mg, 20 mg

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20
Q

Dosage Forms - Carisoprodol

A

Tablet: 250 mg, 350 mg

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21
Q

Dosage Forms - Cyclobenzaprine

A

Tablet: 5 mg, 7.5 mg, 10 mg

ER Capsule: 15 mg, 30 mg

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22
Q

Dosage Forms - Metaxalone

A

Tablet: 400 mg, 800 mg

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23
Q

Dosage Forms - Methocarbamol

A

Tablet: 500 mg, 750 mg

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24
Q

Dosage Forms - Tizanidine

A

Tablet: 2 mg, 4 mg
Capsule: 2 mg, 4 mg, 6 mg

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25
Q

Dosage Forms - Eletriptan

A

Tablet: 20 mg, 40 mg

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26
Q

Dosage Forms - Rizatriptan

A

Tablet: 5 mg, 10 mg

Orally-Disintegrating Tablet: 5 mg, 10 mg

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27
Q

Dosage Forms - Sumatriptan

A 
Tablet: 25 mg, 50 mg, 100 mg
Nasal Solution: 5 mg/actuation
Nasal Exhaler Powder: 11 mg/nosepiece
Solution for Subcutaneous Injection: 3 mg/0.5 mL, 4 mg/0.5 mL, 6 mg/0.5 mL
Transdermal (patch): 6.5 mg/4 h
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28
Q

MOA - Baclofen

A

Inhibits both monosynaptic and polysynaptic reflexes at the spinal level, possibly by hyperpolarization of afferent terminals, although actions at supraspinal sites may also occur and contribute to its clinical effect

Analogue of γ-aminobutyric acid (GABA), but there is no conclusive evidence that actions on GABA systems are involved in the production of its clinical effects.

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29
Q

MOA - Carisoprodol

A

Block interneuronal activity in the descending reticular formation and spinal cord causing muscle relaxation

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30
Q

MOA - Cyclobenzaprine

A

Relieves skeletal muscle spasm of local origin without interfering with muscle function.

Ineffective in muscle spasm due to CNS disease

Evidence suggests that the net effect of cyclobenzaprine is a reduction in tonic motor activity, influencing both gamma (𝛾) and alpha (α) motor systems.

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31
Q

MOA - Metaxalone

A

Not well established likely due to CNS depression. No direct action on the contractile mechanism of striated muscle, the motor end plate, or the nerve fiber.

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32
Q

MOA - Methocarbamol

A

Not well established likely due to CNS depression. No direct action on the contractile mechanism of striated muscle, the motor end plate, or the nerve fiber.

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33
Q

MOA - Tizanidine

A

Imidazole derivative, structurally unrelated to other muscle relaxants - centrally acting muscle relaxant. Agonist of alpha-2 adrenergic receptors leads to decreased spasticity by increasing presynaptic inhibition. NO antihypertensive properties

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34
Q

MOA - Eletriptan

A

Binds with high affinity to serotonin (5-HT) subtypes 1B, 1D, and 1F receptors.

No significant affinity or pharmacological activity at adrenergic α1, α2, or β; dopaminergic D1or D2; muscarinic; or opioid receptors.

Serotonin receptor agonists are believed to be effective in migraine, either through vasoconstriction (via activation of 5-HT1receptors located on intracranial blood vessels) or through activation of 5-HT1receptors on sensory nerve endings in the trigeminal system, resulting in the inhibition of proinflammatory neuropeptide release.

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35
Q

MOA - Rizatriptan

A

Binds with high affinity to serotonin (5HT) receptor subtypes 1B and 1D.

Serotonin receptor agonists are believed to be effective in migraine either through vasoconstriction (via activation of 5-HT1receptors located on intracranial blood vessels) or through activation of 5-HT1receptors on sensory nerve endings in the trigeminal system resulting in the inhibition of proinflammatory neuropeptide release.

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36
Q

MOA - Sumatriptan

A

Binds with high affinity to serotonin (5-HT) subtypes 1B, 1D, and 1F receptors

No significant affinity or pharmacologic activity at adrenergic α1, α2, or β; dopaminergic D1or D2; muscarinic; or opioid receptors.

Serotonin receptor agonists are believed to be effective in migraine either through vasoconstriction (via activation of 5-HT1receptors located on intracranial blood vessels) or through activation of 5-HT1receptors on sensory nerve endings in the trigeminal system resulting in the inhibition of proinflammatory neuropeptide release.

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37
Q

FDA-Approved Indications - Baclofen

A
  1. Spasticity: 5 mg TID (can increase by 5 mg/dose every 3 days) (adult MDD = 80 mg)
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38
Q

FDA-Approved Indications - Carisoprodol

A
  1. Disorder musculoskeletal system: 250-350 mg TID and QHS
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39
Q

FDA-Approved Indications - Cyclobenzaprine

A
  1. Skeletal muscle spasm:
    a) IR: 5 mg TID (can titrate up to 10 mg TID) and treat 2-3 weeks
    b) ER: 15 mg QD (can titrate up to 30 mg QD)
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40
Q

FDA-Approved Indications - Metaxalone

A
  1. Musculoskeletal pain or spasm: 800 mg TID-QID
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41
Q

FDA-Approved Indications - Methocarbamol

A
  1. Musculoskeletal pain or spasm: 1500 mg QID for 48-72 hours (can titrate to 750 mg q4h or 1500 mg TID or 1000 mg QID)
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42
Q

FDA-Approved Indications - Tizanidine

A
  1. Muscle spasticity: 2 mg up to TID (may titrate to 8 mg q6-8h; MDD = 36 mg)
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43
Q

FDA-Approved Indications - Eletriptan

A
  1. Migraine: 20-40 mg at onset of migraine, may repeat in 2 hours PRN (Max single dose: 40 mg; MDD = 80 mg)
44
Q

FDA-Approved Indications - Rizatriptan

A
  1. Migraine (adults): 5-10 mg at onset of migraine, may repeat after 2 h PRN (MDD = 30 mg)
  2. Migraine (children >6 years old and adolescents <40 kg): 5 mg at onset of migraine, multiple doses in a 24 hour period NOT recommended
45
Q

FDA-Approved Indications - Sumatriptan

A
  1. Migraine
    a) Oral: 25-100 mg at onset of migraine, may repeat after 2h PRN (MDD = 200 mg)
    b) Nasal: 5-20 mg in 1 nostril, may repeat after 2h (MDD = 40 mg)
    c) Subcutaneous: inject 6 mg (MDD = 12 mg)
    d) Transdermal: apply 1 patch, may apply a 2nd patch after 2h (MDD = 2 patches)
  2. Cluster headaches: 6 mg SQ once (MDD = 12 mg)
46
Q

Off-Label Uses - Baclofen

A
  1. Intractable hiccoughs: 5-10 mg BID (increase to 15-45 mg/day in 3 divided doses OR 10-20 mg BID-TID)
  2. Alcohol use disorder: 5 mg TID (may increase to 10 mg TID after 3-5 days; MDD = 60 mg)
  3. Muscle spasm and/or musculoskeletal pain: 5 mg TID PRN
47
Q

Off-Label Uses - Cyclobenzaprine

A
  1. Temporomandibular Joint Disorder (TMJ):
    a) IR: 10 mg QD x 3 weeks
  2. Fibromyalgia: 5-10 mg QHS (may titrate to 10-40 mg in 1 to 3 divided doses)
48
Q

Off-Label Uses - Tizanidine

A
  1. Acute low back pain: 2-4 mg q6-12h (MDD = 24 mg) alone or in combination with NSAIDs
49
Q

Kinetics - Baclofen

A

Absorption: F = 100%
Distribution: Vd = 59.1 L; 30% protein bound
Metabolism: Limited
Elimination: Renal 60-80%; T1/2 = 3-7 hours
Hepatic Dose Adjustment: None
Renal Dose Adjustment: Monitor

50
Q

Kinetics - Carisoprodol

A 
Absorption: unknown
Distribution: unknown
Metabolism: hepatic; major CYP2C19 substrate
Elimination: renal; T1/2 = 8 hours
Hepatic Dose Adjustment: low and slow
Renal Dose Adjustment: none
51
Q

Kinetics - Cyclobenzaprine

A 
Absorption: F = 33-55%
Distribution: 93% protein bound
Metabolism: extensive hepatic; CYP1A2 substrate
Elimination: renal 50%; T1/2 = 18 hours
Hepatic Dose Adjustment: 
a) Mild: 5 mg QD (IR; avoid ER)
b) Severe: avoid
Renal Dose Adjustment: none
52
Q

Kinetics - Metaxalone

A 
Absorption: ?? food enhances
Distribution: Vd = 800 L
Metabolism: hepatic; multiple CYP substrate
Elimination: renal; T1/2 = 8-9 hours
Hepatic Dose Adjustment: low and slow
Renal Dose Adjustment: low and slow
53
Q

Kinetics - Methocarbamol

A

Absorption: ??
Distribution: protein-binding 45-50%
Metabolism: hepatic via dealkylation and hydroxylation
Elimination: renal (as metabolites); T1/2 = 1-2 hours
Hepatic Dose Adjustment: low and slow
Renal Dose Adjustment: none

54
Q

Kinetics - Tizanidine

A

Absorption: F = 40%, food increases tablet absorption and decreases capsule absorption; hepatic 1st pass
Distribution: Vd = 2.4 L/kg; 30% protein bound
Metabolism: extensive hepatic; CYP1A2 substrate
Elimination: renal 60%; T1/2 = 2 hours
Hepatic Dose Adjustment: not recommended
Renal Dose Adjustment: CrCl <25 mL/min = reduce dose

55
Q

Kinetics - Eletriptan

A

Absorption: F = 50%; high fat food increases 20-30%
Distribution: Vd = 138 L
Metabolism: hepatic; CYP3A4
Elimination: nonrenal 90%; T1/2 = 4 hours
Hepatic Dose Adjustment: severe = AVOID
Renal Dose Adjustment: none

56
Q

Kinetics - Rizatriptan

A 
Absorption: F = 45%
Distribution: Vd = 110-140 L
Metabolism: hepatic via MAO
Elimination: renal 82%, feces; T1/2 = 2-3 hours
Hepatic Dose Adjustment: none
Renal Dose Adjustment: none
57
Q

Kinetics - Sumatriptan

A

Absorption: F = 15%, high fat food increases
Distribution: Vd = 2.4 L/kg; 14-21% protein bound
Metabolism: hepatic via MAO
Elimination: renal 60%; T1/2 = 2.5 hours
Hepatic Dose Adjustment: max single dose = 50 mg
Renal Dose Adjustment: none

58
Q

Drug Interactions - Cyclobenzaprine

A
  1. CYP1A2 inducers/inhibitors = monitor
  2. CNS depressants (opioids, benzodiazepines, alcohol) = AVOID
  3. Anticholinergic agents = AVOID
59
Q

Drug Interactions - Carisoprodol

A
  1. CYP2C19 inducers/inhibitors = monitor

2. CNS depressants (opioids, benzodiazepines, alcohol) = AVOID

60
Q

Drug Interactions - Metaxalone

A
  1. CNS depressants = AVOID
61
Q

Drug Interactions - Methocarbamol

A
  1. CNS depressants = AVOID
62
Q

Drug Interactions - Tizanidine

A
  1. CYP1A2 inducers/inhibitors = do not co-administer with inhibitors
  2. CNS depressants = AVOID
  3. Phenytoin/Fosphenytoin = monitor
63
Q

Drug Interactions - Eletriptan

A
  1. CYP3A4/5 = monitor
  2. SSRIs = AVOID
  3. Other 5-HT agonists = contraindicated if administered within 24 hours
64
Q

Drug Interactions - Rizatriptan

A
  1. SSRIs = AVOID
  2. Other 5-HT agonists = contraindicated if administered within 24 hours
  3. Ergot alkaloids = contraindicated
  4. MAOI = contraindicated
65
Q

Drug Interactions - Sumatriptan

A
  1. SSRIs = AVOID
  2. Other 5-HT agonists = contraindicated if administered within 24 hours
  3. Ergot alkaloids = contraindicated
  4. MAOI = contraindicated
66
Q

Baclofen in Pregnancy/Lactation

A

Pregnancy: risk
Lactation: probably compatible

67
Q

Carisoprodol in Pregnancy/Lactation

A

Pregnancy: no data
Lactation: probably compatible

68
Q

Cyclobenzaprine in Pregnancy/Lactation

A

Pregnancy: low risk?
Lactation: probably compatible

69
Q

Metaxalone in Pregnancy/Lactation

A

Pregnancy: no data
Lactation: potential toxicity

70
Q

Methocarbamol in Pregnancy/Lactation

A

Pregnancy: low risk
Lactation: probably compatible

71
Q

Tizanidine in Pregnancy/Lactation

A

Pregnancy: risk
Lactation: potential toxicity

72
Q

Eletriptan in Pregnancy/Lactation

A

Pregnancy: moderate risk
Lactation: compatible

73
Q

Rizatriptan in Pregnancy/Lactation

A

Pregnancy: moderate risk
Lactation: probably compatible

74
Q

Sumatriptan in Pregnancy/Lactation

A

Pregnancy: moderate risk
Lactation: probably compatible

75
Q

Black Box Warning - Baclofen

A

Avoid abrupt discontinuation of oral or intrathecal product

76
Q

Drugs with Beers Criteria

A
  1. Carisoprodol
  2. Cyclobenzaprine
  3. Metaxalone
  4. Methocarbamol
77
Q

Contraindications - Carisoprodol

A
  1. Hypersensitivity to meprobamate

2. Acute intermittent porphyria

78
Q

Contraindications - Cyclobenzaprine

A
  1. Concomitant MAOI use
  2. Heart failure
  3. Acute coronary phase of AMI
  4. Heart block
  5. Hyperthyroidism
79
Q

Contraindications - Metaxalone

A
  1. Significantly impaired renal or hepatic function
80
Q

Contraindications - Tizanidine

A
  1. Concurrent use with CYP1A2 inhibitors
81
Q

Contraindications - Eletriptan

A

Cerebrovascular syndromes, hemiplegic or basial migraine, ischemic bowel disease, ischemic heart disease, peripheral vascular disease, severe hepatic impairment, uncontrolled HTN

82
Q

Contraindications - Rizatriptan and Sumatriptan

A

Cerebrovascular syndromes, hemiplegic or basial migraine, ischemic bowel disease, ischemic heart disease, peripheral vascular disease, severe hepatic impairment, uncontrolled HTN, MAOIs, ergot alkaloids

83
Q

Adverse Effects - Baclofen

A

Common: Nausea, asthenia, dizziness, somnolence, confusion

Less common: Constipation, fatigue, hypotension, shivering, urinary symptoms, peripheral edema, difficulty in micturition

Rare but serious: Slowed or difficult breathing when used in combination with opioids, pneumonia, GI hemorrhage, seizure

84
Q

Adverse Effects - Carisoprodol

A

Common: drowsiness, dizziness

Less common: headache

Rare but serious:Slowed or difficult breathing when used in combination with opioids, seizure, drug dependence, withdrawal symptoms upon discontinuation after chronic use

85
Q

Adverse Effects - Cyclobenzaprine

A

Common: Xerostomia, headache, dizziness, drowsiness

Less common: onstipation, indigestion, nausea, pharyngeal dryness, asthenia, confusion, blurred vision

Rare but serious: Cardiac dysrhythmia, cholestasis, hepatitis, jaundice, anaphylaxis, immune hypersensitivity reaction, slowed or difficult breathing when used in combination with opioids

86
Q

Adverse Effects - Metaxalone

A

Common: dizziness

Less common: N/V, headache, somnolence

Rare but serious: Hemolytic anemia, leukopenia, jaundice, immune hypersensitivity reaction, maculopapular rash, slowed or difficult breathing when used in combination with opioids

87
Q

Adverse Effects - Methocarbamol

A

Common: somnolence

Less common: Flushing, pruritus, rash, urticaria, nausea, vomiting, dizziness, headache, nystagmus, vertigo, blurred vision, conjunctivitis

Rare but serious: Bradyarrhythmia, hypotension, syncope, leukopenia, anaphylactoid reaction, slowed or difficult breathing when used in combination with opioids

88
Q

Adverse Effects - Tizanidine

A

Common: Hypotension, xerostomia, asthenia, dizziness, somnolence, muscle weakness

Less common: Constipation, vomiting, dyskinesia, amblyopia, feeling nervous, syncope, depression

Rare but serious: AMI, thrombocytopenia, hepatitis, PE, hypersensitivity, death, slowed or difficult breathing when used in combination with opioids

89
Q

Adverse Effects - Eletriptan

A

Common: weakness

Less common: Nausea, asthenia, dizziness, somnolence

Rare but serious: Angina, cardiac dysrhythmia, coronary arteriosclerosis, heart block, HTN, acute myocardial infarction, aphasia, cerebral ischemia, stroke, dystonia, hemiplegia, neuropathy, transient ischemic attack, oculogyric crisis

90
Q

Adverse Effects - Rizatriptan and Sumatriptan

A

Common: none

Less common: Nausea, asthenia, dizziness, somnolence

Rare but serious: Angina, cardiac dysrhythmia, coronary arteriosclerosis, heart block, HTN, acute myocardial infarction, aphasia, cerebral ischemia, stroke, dystonia, hemiplegia, neuropathy, transient ischemic attack, oculogyric crisis

91
Q

Drug Monitoring - Baclofen

A

Efficacy: Reduction in muscle spasm, passive limb movement and pain relief

Toxicity: Severe dizziness, confusion, sedation, or rebound spasticity occurs.

92
Q

Drug Monitoring - Carisoprodol

A

Efficacy: Reduction in pain and muscle spasms

Toxicity: Idiosyncratic symptoms such as extreme weakness, transient quadriplegia, dizziness, confusion occur within minutes or hours after first dose

93
Q

Drug Monitoring - Cyclobenzaprine

A

Efficacy: Reduction in pain and muscle spasms

Toxicity: Sx of Hepatic failure

94
Q

Drug Monitoring - Metaxalone

A

Efficacy: Reduction in pain and muscle spasms

Toxicity: Monitor LFTs and CBC

95
Q

Drug Monitoring - Methocarbamol

A

Efficacy: Reduction in pain and muscle spasms

Toxicity: Idiosyncratic symptoms such as extreme weakness, transient quadriplegia, dizziness, and confusion occur within minutes or hours after 1st dose; Vital signs

96
Q

Drug Monitoring - Tizanidine

A

Efficacy: Reduction in pain and muscle spasms & in passive limb movement

Toxicity: Monitor BP, LFTs, SCr, and CBC

97
Q

Drug Monitoring - Eletriptan, Rizatriptan, and Sumatriptan

A

Efficacy: Resolution of signs of migraine headache

Toxicity: Ischemic bowel disease (eg, sudden severe abdominal pain, bloody diarrhea) or peripheral vascular disease (eg, Raynaud syndrome), serotonin syndrome (eg, agitation, hallucinations, tachycardia, hyperreflexia, incoordination, diarrhea, nausea), ischemic cardiac syndrome, or hypertensive crisis

98
Q

Counseling and Pearls - Baclofen

A

Counseling: Caution when operating motor vehicles or dangerous machinery due to sedation. CNS effects may be additive when used with alcohol or other CNS depressants.

Pearls: Implantable pumps that administer baclofen intrathecally are also available for patients with spasticity. Constipation occurs in 100% of patients undergoing intrathecal administration, and abrupt discontinuation of intrathecal therapy (intentional or inadvertent) can result in seizures, coma, and death. Avoid concomitant use with opioids.

99
Q

Counseling and Pearls - Carisoprodol

A

Counseling: Avoid consuming alcohol. Avoid activities requiring mental alertness or coordination until drug effects are known, as drug may cause dizziness or sedative effects. Patients withdrawing from prolonged therapy should be monitored carefully for withdrawal symptoms, including seizures.

Pearls: Carisoprodol should be used for only short periods (up to 2 or 3 wk). It was approved in 1959, so limited pharmacologic and kinetic data available. May require tapering at discontinuation after chronic use. Avoid concomitant use with opioids.

100
Q

Counseling and Pearls - Cyclobenzaprine

A

Counseling: Avoid activities requiring mental alertness or coordination until drug effects are known, as drug may cause dizziness or sedative effects. Take extended-release capsule same time each day.

Pearls: Cyclobenzaprine should be used for only short periods (up to 2-3 wk). Avoid concomitant use with opioids. Use with caution in patients with glaucoma, increased IOP, urinary retention, etc, as cyclobenzaprine has anticholinergic-like effects. Avoid use in elderly; may be more sensitive to effects.

101
Q

Counseling and Pearls - Metaxalone

A

Counseling: Avoid activities requiring mental alertness or coordination until drug effects are known, as drug may cause dizziness or sedative effects.

Pearls: Metaxalone should be used for only short periods (up to 2 or 3 wk). Not for use in children <12 y of age. Use with caution in elderly who may be more susceptible to adverse effects. Should avoid concomitant use with opioids.

102
Q

Counseling and Pearls - Methocarbamol

A

Counseling: Avoid activities requiring mental alertness or coordination until drug effects are known, as drug may cause dizziness or sedative effects.

Pearls: Methocarbamol should be used for only short periods (up to 2 or 3 wk). Drug may color urine brown, black, or green. Injectable form available, used for spasticity associated with tetanus. Should avoid concomitant use with opioids.

103
Q

Counseling and Pearls - Tizanidine

A

Counseling: Be cautious of risk of dizziness and somnolence when initiating therapy; do not drive until effects of drug are known. Rise slowly from a lying/sitting position, as this drug may cause hypotension. May cause xerostomia (dry mouth) and asthenia (weakness).

Pearls: While this drug may be taken with or without food, patients should take the drug in the same way (fasting or fed) every time to avoid inconsistent absorption patterns and resulting changes in efficacy and adverse effects. Effect of food on extent of absorption differs for tablets and capsules. Abrupt discontinuation can cause rebound HTN and tachycardia. Taper dose by 2-4 mg/d if used at high dose (20-28 mg daily) or for an extended period of time. Should avoid concurrent use with opioids. Capsules and tablets are not interchangeable.

104
Q

Counseling and Pearls - Eletriptan

A

Counseling: Avoid activities requiring mental alertness or coordination until drug effects are realized, as this drug may cause dizziness or somnolence

Pearls: These agents are not for prophylaxis—these are used for the treatment of acute migraine headache. Several serotonin agonists (“triptans”) exist for migraine, administered via a variety of routes (oral, inhaled, injected). Each differs in onset and duration of action. If an agent is ineffective atmaxdose, recommend changing agents or route. Instruct patient to take a 2nd dose ≥2 h after the 1st if needed, but no >80 mg/d. Overuse of acute migraine medications can lead to medication overuse headache that may present similarly to migraine; may require detoxification including management of withdrawal symptoms.

105
Q

Counseling and Pearls - Rizatriptan

A

Counseling: Avoid alcohol, CNS depressants. Caution with driving and other tasks requiring alertness. Allow disintegrating tablet to dissolve on tongue and then swallow, do not chew.

Pearls: Serotonin agonists are not for prophylaxis; only for the treatment of acute migraine headache. Several serotonin agonists (“triptans”) are available for migraine, administered via a variety of routes (oral, inhaled, and injected). Each differs in onset and duration of action. If one agent is ineffective atmaxdose, recommend changing agents or route.

106
Q

Counseling and Pearls - Sumatriptan

A

Counseling: Avoid activities requiring mental alertness or coordination until drug effects are realized, as this drug may cause dizziness or somnolence.

Pearls: Sumatriptan is also available in formulations for injectable administration, and as an oral dosage form in combination with naproxen. These agents are not for prophylaxis; only for the treatment of acute migraine headache. Several serotonin agonists (“triptans”) exist for migraine, administered via a variety of routes (oral, inhaled, and injected). Each differs in onset and duration of action. If 1 agent is ineffective atmaxdose, recommend changing agents or route.

Top Drugs 1 (5 decks)

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