Eletriptan

Eletriptan is a second-generation selective 5-HT1B/1D receptor agonist with higher oral bioavailability than sumatriptan. It constricts dilated intracranial blood vessels via 5-HT1B receptor activation on vascular smooth muscle and inhibits release of pro-inflammatory neuropeptides (CGRP, substance P) from trigeminal nerve endings via 5-HT1D receptor activation, reversing the pathophysiology of migraine. Its greater lipophilicity enhances CNS penetration compared to first-generation triptans.

Adult

40 mg, followed by 40 mg after 2 hours if required (dose to be taken only if migraine recurs; patient not responding to initial dose should not take second dose for same attack); increased if necessary to 80 mg for subsequent attacks if 40 mg dose inadequate

Renal adjustment

Max. 12.5 mg in 24 hours if eGFR less than 30 mL/minute/1.73 m2

Hepatic adjustment

Manufacturer advises caution in mild to moderate impairment; avoid in severe impairment.

Geriatric

Not licensed for use in elderly.

Max dose

80 mg per day

• Arrhythmias
• Coronary vasospasm
• Heart failure
• Ischaemic heart disease
• Peripheral vascular disease
• Previous cerebrovascular accident
• Previous myocardial infarction
• Previous transient ischaemic attack
• Prinzmetal’s angina
• Severe hypertension
• Uncontrolled hypertension
• Severe hepatic impairment
• Ischemic heart disease
• Coronary artery vasospasm
• Hepatic disease
• Within 24 hours of another triptan
• Within 24 hours of an ergot derivative
• Within 24 hours of SSRIs
• Within 24 hours of SNRIs