NaratriptanNaratriptan Hydrochloride

About Naratriptan

Naratriptan is a triptan: it binds strongly to 5-HT1B and 5-HT1D serotonin receptors. It treats an attack once it has begun; it is not for preventing migraine, and its safety and effectiveness in cluster headache have not been established. The dose is 1 mg or 2.5 mg, taken with water or another liquid; if the headache comes back or eases only partly, the dose may be repeated once, at least 4 hours after the first, with no more than 5 mg in 24 hours. In mild to moderate kidney or liver impairment a 1 mg starting dose is recommended and the most in a day is 2.5 mg, and the safety of treating more than four attacks in 30 days on average has not been established.

Tingling, dizziness, drowsiness, tiredness and throat or neck symptoms are the most common side effects. Tightness, pain or pressure in the chest, throat, neck or jaw is usually not from the heart, but triptans can rarely cause heart attacks, dangerous heart rhythms, strokes and spasm of blood vessels elsewhere, so someone with several heart risk factors may need a heart check before the first dose. It must not be taken with coronary artery disease or coronary spasm, Wolff-Parkinson-White syndrome or similar rhythm problems, a past stroke or TIA, hemiplegic or basilar migraine, peripheral vascular or ischemic bowel disease, uncontrolled high blood pressure, severe kidney impairment (creatinine clearance below 15 mL/min) or severe liver impairment, or within 24 hours of another triptan or an ergot medicine such as dihydroergotamine.

With SSRI or SNRI antidepressants, tricyclics or MAO inhibitors it can contribute to serotonin syndrome, whose signs include agitation, hallucinations, a fast heartbeat, fever, overactive reflexes, poor coordination, nausea and diarrhea. Using acute migraine medicines on 10 or more days a month can cause medication-overuse headache, daily migraine-like headaches or much more frequent attacks, which may need the overused drugs withdrawn. Blood pressure can rise sharply on rare occasions, even in people without high blood pressure, and severe allergic reactions have occurred. It is not recommended for anyone under 18. Amerge has been discontinued in both strengths, and the generic tablets come from a few makers, in packs of nine or in larger bottles.

Taking Naratriptan

How to take it

Swallow one tablet with water or another liquid once a migraine has started. If the headache returns or eases only partly, one more dose may be taken at least 4 hours after the first, never more than 5 mg in 24 hours. If the first dose does not help at all, call the prescriber before taking a second.

If you miss a dose

It is taken only for a migraine attack, so there is no schedule to miss.

Storage

At room temperature in the original package, away from heat and moisture (not in the bathroom), out of reach of children. Use a take-back program for unused tablets rather than flushing them.

Interactions to know about

Do not take it within 24 hours of another triptan, such as sumatriptan or zolmitriptan, or an ergot such as dihydroergotamine. SSRI, SNRI and tricyclic antidepressants and MAO inhibitors can contribute to serotonin syndrome. Call the prescriber right away or get emergency help for tightness, pain, pressure or heaviness in the chest, throat, neck or jaw, shortness of breath, or sudden or severe stomach pain.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Naratriptan differs from pharmacy to pharmacy

Generic naratriptan comes from only a few makers, so it may not be on a pharmacy’s flat-price generic list, quotes for the same tablet can differ, and a pharmacy that seldom fills it may need to order it. It is taken only for attacks, so a fill can be small, such as one pack of nine, and the dispensing fee is then a large share of the price.

Ways to pay less for Naratriptan without insurance

• Compare quotes from more than one pharmacy, and ask whether naratriptan is on a flat-price generic list.
• If you treat attacks regularly, ask the prescriber whether a larger quantity per fill would suit you, so one dispensing fee covers more doses.
• Ask whether your strength is in stock before the prescription is sent, since a pharmacy may need to order it.
• If it is quoted high, ask the prescriber whether another generic triptan, such as sumatriptan or rizatriptan, would suit you.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Naratriptan

1. 1.Is it safe with my heart condition, blood pressure or kidney function?
2. 2.Is it safe with my antidepressant?
3. 3.How many days a month can I use it without risking rebound headaches?
4. 4.How long must I wait after taking another triptan or dihydroergotamine?

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