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Tolerability of the Triptans

Clinical Implications

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Abstract

The triptans represent a relatively new class of compounds effective in the treatment of migraine. The safety and tolerability of these drugs have been extensively investigated since the first triptan (sumatriptan) became commercially available.

A report on a very large population of patients tested during clinical trials and in postmarketing studies, confirms that these drugs are safe and well tolerated when correctly used.

Adverse events are frequently reported, but are usually mild and only a few patients discontinue therapy because of them. These adverse events include, in particular, the so-called ‘triptan symptoms’ (tingling, sensation of warmth, etc.). The exact mechanism of chest symptoms reported by 20% of patients with migraine treated with triptans remains unclear, but are exceptionally related to a cardiac mechanism.

CNS adverse events (i.e. somnolence) are also reported, but it is a matter of debate whether they are related to the pharmacological properties (i.e. lipophilicity) of the drug or are symptoms of the disease itself.

The potential risk for drug overuse must be taken into account when the triptans are given to patients with a high frequency of migraine attacks.

Clinical interaction of triptans with other drugs metabolised in the liver may theoretically influence the incidence of adverse events, but there is little evidence to support this assumption.

There is no evidence of a teratogenic risk of triptans in pregnant women taking these drugs.

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Acknowledgments

Supported by a grant from the Minister of Health RC 010 45B. We want to thank Mrs Catherine Wrenn for her revision of the English in the manuscript and Mrs Cristina Rivieccio and Patrizia Baldi for their secretarial support.

The authors are consultants to, and have received travel and grant support from most of the pharmaceutical companies involved in the manufacturing and marketing of the drugs discussed in this paper. Their salaries are all fully covered by their employers.

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Authors and Affiliations

  1. University Centre for Adaptive Disorders and Headache, IRCCS ‘C. Mondino Foundation’, University of Pavia, Via Palestro 3, 27100, Pavia, Italy

    Giuseppe Nappi, Giorgio Sandrini & Grazia Sances

  2. IV Chair of Neurology, Department of Neurology and Otorhinolaryngology, University of Rome ‘La Sapienza’, Rome, Italy

    Giuseppe Nappi

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  1. Giuseppe Nappi
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  2. Giorgio Sandrini
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Correspondence to Giuseppe Nappi.

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Nappi, G., Sandrini, G. & Sances, G. Tolerability of the Triptans. Drug-Safety 26, 93–107 (2003). https://doi.org/10.2165/00002018-200326020-00003

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