The Triptans

@article{Tepper1999TheT,
  title={The Triptans},
  author={Stewart J. Tepper and Alan M. Rapoport},
  journal={CNS Drugs},
  year={1999},
  volume={12},
  pages={403-417}
}
New migraine-specific medications, the triptans, are changing the clinician’s approach to the treatment of migraine. These drugs are pharmacologically based on agonism of serotonin (5-hydroxytryptamine; 5-HT) receptors.The triptans are selective 5-HT1B/1D receptor agonists and are believed to reverse the mechanisms of migraine, which may include changes in durai vessel calibre, neurogenic inflammation and central trigeminal neuronal activation.The first marketed triptan was sumatriptan… 
The Triptan Formulations
TLDR
The clinician has in his/her armamentarium an ever-expanding variety of triptans, available in multiple formulations and dosages, which have good safety and tolerability profiles and it should become possible for the interested physician to match individual patient needs with the specific characteristics of a triptan to optimise therapeutic benefit.
Tolerability of the Triptans
TLDR
A report on a very large population of patients tested during clinical trials and in postmarketing studies, confirms that these triptans are safe and well tolerated when correctly used.
Triptans are all different.
TLDR
What makes sumatriptandifferent is the flexibility of form, combined with the unmatched speed and potency of the injection and the speed of onset of the nasal spray, both forms being faster in onset than all oral triptans.
Triptans in migraine. A review of side effects, improvement and recurrence
TLDR
A quick but exhaustive schedule type is established, merely in order to standardize all data obtained through a few fixed parameters and therefore directly comparable on the currently available compounds.
Clinically Significant Drug Interactions with Agents Specific For Migraine Attacks
TLDR
Nearly all the clinically important interactions between the ergopeptide antimigraine agents and currently marketed drugs are likely to have already come to notice.
Acute treatment of migraine and the role of triptans
  • F. Freitag
  • Medicine
    Current neurology and neuroscience reports
  • 2001
TLDR
There exist increasing options for migraine treatment that may further improve the clinical effects of the older and newer triptans through early treatment of migraine at the stages of mild migraine pain, or even during the prodromal phase of the attack.
Individual triptan selection in migraine attack therapy.
TLDR
This work presents a state-of-the-art of the triptan selection in treatment of moderate-severe migraine attacks and recommends seven triptans based on efficacy, safety, pharmacokinetics and pharmacodynamics.
Gastric motor effects of triptans: open questions and future perspectives.
TLDR
The available evidence warrants further studies to clarify the mechanism responsible for the gastric motor effect of sumatriptan, the effects on gastric motility/visceral sensitivity of second-generation triptans, and the possible use of drugs improving gastric accommodation to a meal in the management of those dyspeptic patients with impaired fundic relaxation/altered visceral sensitivity.
ACUTE TREATMENT OF MIGRAINE
The goals of acute treatment in migraine should be sustained pain-free response, which will reduce disability and optimally restore function with minimal adverse events and cost. A validated
OnabotulinumtoxinA injections: treatment of reversible cerebral vasoconstriction syndrome chronic daily headaches
TLDR
OBT-A injections may prove a successful, novel treatment for RCVS-CDH, a rare condition characterised by repetitive, multifocal, vasofluctuations of cerebral arteries.
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References

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Serotonin 5-HT1B/1D Receptor Agonists in Migraine
TLDR
Some aspects of the pharmacokinetics of the various triptans, such as the relationship between time to reach peak plasma concentrations and half-lives and clinical efficacy, may reveal information about the fundamental processes at work in acute migraine.
The clinical profile of sumatriptan: efficacy in migraine.
TLDR
Sumatriptan was an effective treatment for migraine with and without aura and when used at any time during the attack, with no evidence of tachyphylaxis or dependence.
The effects of moclobemide on the pharmacokinetics of the 5-HT1B/1D agonist rizatriptan in healthy volunteers.
TLDR
Moclobemide inhibited the metabolism of rizatriptan and its active N-monodesmethyl metabolite through inhibition of MAO-A, and may considerably potentiate riz atriptan action.
Long-term experience with sumatriptan in the treatment of migraine.
TLDR
In long-term studies the high efficacy of sumatriptan is maintained, and the adverse event profile is unchanged and unaffected by attack frequency, which is consistent with previous studies.
311C90: Long-term efficacy and tolerability profile for the acute treatment of migraine
TLDR
The efficacy profile and the nature/incidence of adverse events reported appear to be consistent with previous 311C90 studies, and the dosing regimen was well tolerated during multiple exposures.
Oral Rizatriptan Versus Oral Sumatriptan: A Direct Comparative Study in the Acute Treatment of Migraine
TLDR
This randomized, double‐blind, triple‐dummy, parallel‐groups study concludes that rizatriptan 10 mg has a rapid onset of action and relieves headache and associated symptoms more effectively than sum atriptan 100 mg.
Sumatriptan nasal spray for the acute treatment of migraine
TLDR
It is determined that sumatriptan nasal spray is a rapidly effective, well-tolerated migraine treatment.
Intranasal sumatriptan for the acute treatment of migraine
TLDR
Two double-blind, placebo-controlled, randomised, multicenter, multinational, parallel-group studies were carried out and indicate that administering sumatriptan as a divided dose via two nostrils confers no significant advantage over single-nostril administration.
Efficacy and Safety of Rizatriptan Versus Standard Care During Long‐term Treatment for Migraine
TLDR
Rizatriptan 10 mg was consistently superior, both to the 5‐mg dose and to standard care, in providing relief in 90% of attacks, with 50% pain‐free by 2 hours after dosing.
A triptan too far?
  • P. Goadsby
  • Medicine
    Journal of neurology, neurosurgery, and psychiatry
  • 1998
TLDR
This editorial attempts to provide a summary of the new compounds and formulations which will be a basis for defining the new medicines’ place in clinical practice as the second generation of the triptans emerge.
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