Naratriptan

Naratriptan is a prescription medication used for the treatment of migraine. 

• Naratriptan is available under the following different brand names: Amerge.

Common side effects of Naratriptan include:

• Dizziness,
• Drowsiness,
• Weakness,
• Tiredness,
• Numbness or tingling,
• Flushing (warmth, redness, or tingly feeling),
• Nausea, and
• Pain or tightness in the jaw, neck, or throat

Serious side effects of Naratriptan include:

• Hives,
• Difficulty breathing,
• Swelling of the face, lips, tongue, or throat,
• Fast or pounding heartbeats,
• Numbness or tingling in your fingers or toes,
• Pale or blue-colored appearance in the fingers or toes,
• pain or heavy feeling in the legs,
• Hip pain,
• Burning pain in your feet,
• Sudden and severe stomach pain,
• Bloody diarrhea,
• Constipation,
• Fever,
• Weight loss,
• Severe headache,
• Blurred vision,
• Pounding in the neck or ears,
• Nosebleed,
• Anxiety,
• Confusion,
• Severe chest pain,
• Shortness of breath,
• Irregular heartbeats,
• Seizure,
• Chest pain or pressure,
• Pain spreading to the jaw or shoulder,
• Nausea,
• Sweating,
• Agitation,
• Hallucinations,
• Overactive reflexes,
• Vomiting,
• Diarrhea,
• Loss of coordination,
• Fainting,
• Sudden numbness or weakness (especially on one side of the body),
• Sudden severe headache,
• Slurred speech, and
• Problems with vision or balance

Rare side effects of Naratriptan include:

• None 

Seek medical care or call 911 at once if you have the following serious side effects:

• Severe headache, confusion, slurred speech, arm or leg weakness, trouble walking, loss of coordination, feeling unsteady, very stiff muscles, high fever, profuse sweating, or tremors;
• Serious eye symptoms such as sudden vision loss, blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights;
• Serious heart symptoms include fast, irregular, or pounding heartbeats; fluttering in the chest; shortness of breath; sudden dizziness, lightheadedness, or passing out. 

This is not a complete list of side effects and other serious side effects or health problems that may occur because of the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may report side effects or health problems to FDA at 1-800-FDA-1088.

Adult dosage

Tablet

• 1 mg
• 2.5 mg

Migraine

Adult dosage

• 1-2.5 mg orally at onset; may repeat once after 4 hours.
• Not to exceed 5 mg/day

Dosage Considerations – Should be Given as Follows: 

• See “Dosages”

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first.

• Naratriptan has severe interactions with the following drugs:
  • almotriptan
  • bromocriptine
  • cabergoline
  • dihydroergotamine
  • dihydroergotamine intranasal
  • eletriptan
  • ergoloid mesylates
  • ergotamine
  • frovatriptan
  • methylergonovine
  • rizatriptan
  • sumatriptan
  • sumatriptan intranasal
  • zolmitriptan
• Naratriptan has serious interactions with the following drugs:
  • citalopram
  • cyclobenzaprine
  • desvenlafaxine
  • dolasetron
  • granisetron
  • isocarboxazid
  • linezolid
  • lorcaserin
  • methylene blue
  • netupitant/palonosetron
  • ondansetron
  • ozanimod
  • palonosetron
  • phenelzine
  • procarbazine
  • rasagiline
  • tedizolid
  • tranylcypromine
  • vilazodone
  • vortioxetine
• Naratriptan has moderate interactions with at least 85 other drugs.
• Naratriptan has minor interactions with the following drugs:
  • duloxetine
  • escitalopram
  • ethinylestradiol
  • fluoxetine
  • mestranol
  • milnacipran
  • nefazodone
  • paroxetine
  • sertraline
  • trazodone
  • venlafaxine

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drug interactions. Therefore, before using this product, tell your doctor or pharmacist about all your products. Keep a list of all your medications with you and share this information with your doctor and pharmacist. Check with your healthcare professional or doctor for additional medical advice, health questions, or concerns.

Contraindications

• Hypersensitivity, including angioedema and anaphylaxis.
• Severe hepatic or renal impairment
• Wolff-Parkinson-White syndrome or arrhythmias associated with other cardiac accessory conduction pathway disorders.
• Ischemic heart disease (angina pectoris, history of myocardial infarction, or documented silent ischemia) or coronary artery vasospasm, including Prinzmetal’s angina)
• History of stroke or TIA, or history of hemiplegic or basilar migraine because such patients are at a higher risk of stroke.
• Peripheral vascular disease
• Ischemic bowel disease
• Uncontrolled hypertension
• Within 24 hours of another 5-HT 1 agonist, ergotamine-containing medication, or ergot-type medication (such as dihydroergotamine or methysergide)

Effects of drug abuse

• None

Short-Term Effects

• See “What Are Side Effects Associated with Using Naratriptan?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Naratriptan?”

Cautions

• Decrease dose with mild-moderate renal impairment.
• Anaphylaxis/anaphylactoid and hypersensitivity reactions, including angioedema reported (see Contraindications)
• May cause dizziness, weakness, or drowsiness (infrequent)
• Life-threatening disturbances of cardiac rhythm, including ventricular tachycardia and ventricular fibrillation leading to death, reported within a few hours following the administration of 5-HT1 agonists; discontinue therapy if these disturbances occur.
• Sensations of tightness, pain, and pressure in the chest, throat, neck, and jaw commonly occur after treatment and are usually non-cardiac in origin; however, perform a cardiac evaluation if these patients are at high cardiac risk.
• Therapy may cause non-coronary vasospastic reactions, such as peripheral vascular ischemia, gastrointestinal vascular ischemia and infarction (presenting with abdominal pain and bloody diarrhea), splenic infarction, and Raynaud’s syndrome; in patients who experience symptoms or signs suggestive of non-coronary vasospasm reaction following the use of any 5-HT1 agonist, rule out a vasospastic reaction before receiving additional doses.
• Reports of transient and permanent blindness and significant partial vision loss were reported with the use of 5-HT1 agonists; since visual disorders may be part of a migraine attack, a causal relationship between these events and the use of 5-HT1 agonists has not been established.
• Serotonin syndrome
  • Serotonin syndrome may occur, particularly during coadministration with selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), and monoamine oxidase (MAO) inhibitors.
  • Serotonin syndrome symptoms may include mental status changes (. g, agitation, hallucinations, coma), autonomic instability (. g, tachycardia, labile blood pressure, hyperthermia), neuromuscular aberrations (.g, hyperreflexia, incoordination), and/or gastrointestinal symptoms (.g, nausea, vomiting, diarrhea)
  • The onset of symptoms usually occurs within minutes to hours of receiving a new or a greater dose of a serotonergic medication; discontinue therapy if serotonin syndrome is suspected.
  • Significant elevation in blood pressure, including hypertensive crisis with acute impairment of organ systems, reported on rare occasions in patients treated with 5-HT1 agonists, including patients without a history of hypertension; monitor blood pressure in patients receiving therapy; the drug is contraindicated in patients with uncontrolled hypertension.
• Medication overuse
  • Overuse of acute migraine drugs (.g, ergotamine, triptans, opioids, or a combination of these drugs for above 10 days/month) may lead to exacerbation of headache (medication overuse headache)
  • Medication overuse headaches may present as migraine-like daily headaches or as a marked increase in the frequency of migraine attacks; detoxification of patients, including withdrawal of overused drugs, and treatment of withdrawal symptoms (which often includes a transient worsening of headache) may be necessary.
• Cerebrovascular events
  • Cerebral hemorrhage, subarachnoid hemorrhage, and stroke have occurred in patients treated with 5-HT1 agonists, and some have resulted in fatalities.
  • In several cases, it appears possible that the cerebrovascular events were primary, the 5-HT1 agonist having been administered in the incorrect belief that the symptoms experienced were a consequence of migraine when they were not.
  • Also, patients with migraine may be at increased risk of certain cerebrovascular events (.g, stroke, hemorrhage, TIA)
  • Discontinue drug if a cerebrovascular event occurs; before treating headaches in patients not previously diagnosed as migraineurs, and in migraineurs who present with symptoms atypical for migraine, exclude other potentially serious neurological conditions
• Myocardial ischemia, infarction, and Prinzmetal’s angina
  • Serious cardiac adverse reactions, including acute myocardial infarction, occurring within a few hours following administration of therapy were reported; some of these reactions occurred in patients without known CAD; therapy may cause coronary artery vasospasm (Prinzmetal’s angina) even in patients without a history of CAD
  • Perform a cardiovascular evaluation in triptan-naive patients who have multiple cardiovascular risk factors (.g, increased age, diabetes, hypertension, smoking, obesity, strong family history of CAD) before receiving therapy; if there is evidence of CAD or coronary artery vasospasm, AMERGE is contraindicated
  • For patients with multiple cardiovascular risk factors who have a negative cardiovascular evaluation, consider administering the first dose in a medically supervised setting and performing an electrocardiogram (ECG) immediately following administration; for such patients, consider periodic cardiovascular evaluation in intermittent long-term treatments.

Pregnancy and Lactation

• There are no adequate data on the developmental risk associated with the use of naratriptan in pregnant women; several studies have suggested that women with migraine may be at increased risk of preeclampsia during pregnancy.
• Lactation
  • There are no data on the presence of naratriptan in human milk, the effects of naratriptan on the breastfed infant, or the effects of naratriptan on milk production; naratriptan is present in rat milk; the developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for naratriptan and any potential adverse effects on the breastfed infant from naratriptan or the underlying maternal condition.