Other Triptans. Newer oral triptans include almotriptan (Axert), zolmitriptan (Zomig), naratriptan (Naramig, Amerge), rizatriptan (Maxalt), frovatriptan (Frova), and eletriptan (Relpax). In general, these drugs are similar, but there are some significant differences. Studies on the newer oral drugs have reported pain relief within 2 hours equal to that of injected sumatriptan in 60 - 91% of patients.
Comparison studies with sumatriptan suggest that some of the newer drugs have fewer side effects and are superior to sumatriptan for providing immediate, sustained, and consistent pain relief. Recurrence rates are also lower. They are also being investigated for prevention under certain circumstances, such as menstrual migraines, but benefits appear limited.
Some observations:
- Almotriptan is as effective as oral sumatriptan and may have fewer side effects, particularly chest pain, than most other triptans. It may prove to be one of the most cost effective of these drugs.
- Rizatriptan may have the most rapid effects of all oral triptans. Zolmitriptan also has a more rapid effect than sumatriptan (although there appears to be no significant difference in adverse effects). Both rizatriptan and zolmitriptan are also available as rapidly dissolving wafers.
- Eleptriptan is also very rapidly effective at high doses, but at those levels may have significant adverse effects. (To date, it does not seem to have any advantages over other triptans in head-to-head comparisons.)
- Naratriptan and frovatriptan have a delayed response but long duration, few side effects, and lower risk for recurrence than with sumatriptan. Some evidence suggests that they may have specific benefits for stopping prolonged migraines and may even play a role in prevention.
- Frovatriptan: A large study of more than 500 women with an average 12-year history of menstrual migraines examined the use of frovatriptan for the short-term prevention of such headaches. Researchers found that the migraines disappeared in over half of the women on the higher dose (5 mg) of frovatriptan.
- Zolmitriptan (Zomig): A study presented at the 2005 annual meeting of the American Headache Society suggested that zolmitriptan nasal spray may be safe and effective for adolescents. Zolmitriptan relieved pain within 2 hours for nearly half of the children (aged 12-17 years) enrolled in the trial. Zolmitriptan nasal spray is currently approved only for adults.
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