Naratriptan

Naratriptan is a selective 5-HT1B/1D receptor agonist that constricts dilated meningeal blood vessels and inhibits trigeminal neuropeptide release, reversing the pathophysiology of migraine. Compared to sumatriptan, naratriptan has a longer plasma half-life (~6 hours vs 1-2 hours), higher oral bioavailability (70%), and slower onset, making it better suited for migraines with gradual onset or prolonged duration and associated with lower headache recurrence rates.

Adult

2.5 mg orally; can be repeated after 2 hours if initial dose is inadequate.

Renal adjustment

Avoid if eGFR less than 15 mL/minute/1.73 m2. Max. 2.5 mg in 24 hours.

Hepatic adjustment

Avoid in severe impairment (no information available from manufacturer).

• eGFR less than 15 mL/minute/1.73 m2
• Severe hepatic impairment
• Pregnancy (manufacturers advise avoidance unless potential benefit outweighs risk)
• Ischemic heart disease
• Coronary artery vasospasm
• Severe renal impairment
• Within 24 hours of another triptan
• Within 24 hours of an ergot derivative
• Within 24 hours of SSRIs
• Within 24 hours of SNRIs