Comparison Of 'Triptan' Drugs
In our latest question and answer, the pharmacist compares all of the available 'Triptan' drugs and provides a comparison chart.
Can you compare Triptans? I've tried a few and, after doing some research, there are so many more! I'm a little overwhelmed. Can you help sort them out?
Last updated Nov 24, 2022
- There are a variety of Triptan drugs available, and they come in a multitude of dosage forms (e.g., tablet, nasal spray, injection).
- All oral Triptans are relatively similar in terms of their effectiveness, onset of action, and side effects.
- Studies have shown that rizatriptan is likely the most effective for a higher percentage of individuals and that frovatriptan is the longest-lasting.
- Overall, the choice of a triptan should be individualized. The specific properties, dosage form, and prior response to other Triptans should all be considered.
- Non-oral Triptans represent a good therapy option for those that need a faster onset of action or cannot tolerate oral Triptans due to symptoms of nausea and vomiting.
You're right that there are a number of different 'Triptan' drugs on the market, and it can be difficult to sort through them all. I have included a chart in this answer that helps to break them down.
First and foremost, although there are plenty of Triptan options, and there are some minor differences between them, all Triptans are considered relatively comparable in terms of how well they work. Differences in efficacy, safety, and tolerability are small and highly individual.
Nevertheless, the minor differences between them can be impactful for certain individuals, so I have provided a breakdown in the section below.
Triptan Drug Comparison Chart
|Generic Name||Brand Name||Dosage Range||Minimum Time Between Doses||Max Dose/24 Hours||% Experiencing Pain Relief at 2 Hours||Onset Of Action||Time To Max Concentration||Half-Life||Comments|
||Adults: 6.25 to 12.5 mg, may repeat dose in 2 hours
||2 Hours||25mg||Adults: 55.4% to 55.6% (6.25 mg); 57.1% to 64.9% (12.5 mg)||30 minutes (12.5 mg)||1 to 3 hours||3 to four hours||FDA-approved for the acute treatment of migraine in children or adolescents
|Eletriptan||Relpax||20 or 40 mg, may repeat dose in 2 hours||2 Hours||80 mg||47.3% to 54.3% (20 mg); 53.9% to 65% (40 mg)||30 minutes (40 mg)||1.5 to 2 hours||4 hours||n/a|
|Frovatriptan||Frova||2.5 mg ORALLY, may repeat dose in 2 hours||2 Hours||7.5 mg||39% to 46% (2.5 mg)||2 hours (2.5 mg)||2 to 4 hours||26 hours||Longest-acting Triptan|
|Naratriptan||Amerge||1 or 2.5 mg ORALLY, may repeat dose in 4 hours||4 Hours||5 mg||At 2 hours after treatment: No data available; At 4 hours: 50% to 54% (1 mg); 60% to 66% (2.5 mg)||1 hour (2.5 mg)||2 to 4 hours||6 hours||n/a|
|Rizatriptan||Maxalt/Maxalt- MLT (dissolving)||Adults: 5 or 10 mg ORALLY, may repeat dose in 2 hours; Pediatric (6 to 17 years): 5 mg (less than 40 kg); 10 mg (40 kg or greater) ||2 Hours; re-dosing not recommended for children||Adults: 30 mg; Pediatric 1 dose (either 5 mg or 10 mg, based on weight)||Oral tablets: 62% (5 mg), 71% to 77% (10 mg); Orally-disintegrating tablets (Maxalt-MLT): 59% to 66% (5 mg); 66% to 74% (10 mg)||30 minutes (5 mg, 10 mg)||1 to 1.5 hours (oral tablet); or up to 2.2 hours (orally disintegrating tablet)||2 to 3 hours||Triptan that shows the greatest response rate.|
FDA-approved for the acute treatment of migraine in children or adolescents
|Sumatriptan NASAL Spray||Imitrex||5 to 20 mg INTRANASALLY, may repeat dose in 2 hours||2 Hours||40 mg||45% to 49% (5 mg); 43% to 54% (10 mg); 55% to 64% (20 mg)||15 minutes (20 mg)||no data available||2 hours||Evidence for benefit in treating cluster headaches|
|Sumatriptan NASAL Powder||Onzetra; Xsail||22 mg (2 nosepieces, 11 mg each) INTRANASALLY, may repeat dose in 2 hours||2 Hours||44 mg/4 nosepieces||68%||30 minutes||45 minutes||3 hours||Evidence for benefit in treating cluster headaches|
|Sumatriptan Succinate ORAL tablet||Imitrex||5 to 20 mg INTRANASALLY, may repeat dose in 2 hours||2 Hours||200 mg||52% (25 mg); 54% to 61% (50 mg); 56% to 62% (100 mg)||30 minutes (25 mg, 50 mg, 100 mg)||2.5 hours||2.5 hours||Evidence for benefit in treating cluster headaches|
|Sumatriptan Succinate INJECTION||Imitrex; STATDose; Sumavel; Alsuma||1 to 6 mg (Imitrex), 4 or 6 mg (Sumavel DosePro), or 6 mg (Alsuma), may repeat after 1 hour||1 Hour||12 mg||40% to 70% (1 mg to 6 mg); 57% (4 mg); 81% (6 mg)||10 minutes (6 mg)||12 minutes||103 to 115 minutes||Only Triptan available as an injection|
Evidence for benefit in treating cluster headaches
|Sumatriptan Succinate transdermal patch||Zecuity||Apply one 6.5-mg patch TRANSDERMALLY, may apply another patch after 2 hours||n/a||13 mg (2 patches)||53%||no data available||1.1 hours||3.1 hours||Off-market; no longer available|
|Sumatriptan Succinate/Naproxen Sodium||Treximet||Sumatriptan 85 mg/naproxen 500 mg ORALLY, may repeat in 2 hours||2 Hours||sumatriptan 170 mg/naproxen 1000 mg (2 tablets)||57% to 65%||no data available||sumatriptan: 1 hour; naproxen 5 hours||sumatriptan: 2 hours; naproxen: 19 hours||Evidence for benefit in treating cluster headaches|
|Zolmitriptan ORAL tablet||Zomig; Zomig ZMT||1.25 (one-half oral tablet) or 2.5 mg ORALLY, may repeat dose in 2 hours; maximum single dose is 5 mg||2 Hours||10 mg||Oral tablets: 62% to 65% (2.5 mg); 59% to 67% (5 mg); Orally-disintegrating tablets: 63% (2.5 mg)||1 hour (2.5 mg)||1.5 hours (oral tablet); 3 hours (orally disintegrating tablet)||3 hours (oral tablet)||Evidence for benefit in treating cluster headaches|
|Zolmitriptan NASAL spray||Zomig||Nasal Spray: 2.5 mg INTRANASALLY, may repeat in 2 hours; maximum single dose is 5 mg||2 Hours||10 mg||55% (2.5 mg); 69% (5 mg)||no data available||no data available||3 hours||Evidence for benefit in treating cluster headaches|
How Do 'Triptans' Work?
'Triptan' drugs are serotonin receptor agonists. They work by stimulating serotonin receptors (5-HT1B and 5-HT1D). Stimulation of these receptors inhibits vasodilation (i.e., promotes vasoconstriction) and inflammation. Additionally, Triptans are thought to work by altering the transmission of pain.
In general, Triptans are for the acute treatment of migraines and are considered most effective when used at the first sign of a migraine.
How Do Triptans Compare?
The chart above breaks down various aspects of Triptan drugs, including their dosing, how well they work, their onset of action, and the percentage of individuals that experience pain relief within a 2-hour window.
In terms of oral Triptans, studies show that rizatriptan (generic for Maxalt) is likely the most effective, but again, Triptans are all relatively comparable in this regard, and one may work better than another for specific individuals. In fact, a number of studies suggest that individuals who do not respond to one Triptan may respond to another.
Frovatriptan (generic for Frova) lasts the longest, and studies have evaluated it for the use of preventing menstrual migraine due to its long duration of action (it is not FDA-approved for this though).
Outside of your oral Triptan options, there are nasal sprays, patches, and injections.
Oral formulations of Triptans are the most popular, but because symptoms of migraine include nausea and vomiting, sometimes non-oral Triptans represent the best treatment option.
The injections are the fastest acting, but come with the caveat that they need to be injected, which many individuals don't want to do. Nose spray products are another option that generally work faster than oral tablets.
Lastly, it is important to note that only two Triptans are approved for use in children, rizatriptan, and almotriptan.
Studies show that, as a drug class, Triptans are effective and relatively safe for most individuals suffering from migraines.
There is some concern regarding the cardiovascular risk of using Triptans.
However, most studies have found no association between Triptan use and the risk of cardiovascular events such as stroke and heart attack in those who do not have certain cardiovascular risk factors. One such study reported the following:
In general practice, triptan treatment in migraine does not increase the risk of stroke, MI, cardiovascular death, IHD, or mortality. Triptans are prescribed to those less at risk of these events.
If you do have cardiovascular risk factors, such as a prior heart attack or stroke, Triptan medications are generally avoided.
It is important to note that Triptans are associated with 'medication overuse headache'. For this reason, all Triptans are recommended to be limited to no more than 10 days of use per month.
This answer isn't intended to be a complete analysis of Triptans, but rather a quick overview hitting on the important points.
Thanks for your question and if you have anything else you want us to go over, reach back out to one of our pharmacists!
- Triptans in migraine: a comparative review of pharmacology, pharmacokinetics and efficacy, PubMed
- Comparison of New Pharmacologic Agents With Triptans for Treatment of Migraine, PubMed
- Comparative efficacy of triptans for the abortive treatment of migraine: a multiple treatment comparison meta-analysis, PubMed
- Triptans in migraine: the risks of stroke, cardiovascular disease, and death in practice, PubMed
- Practice parameter: evidence-based guidelines for migraine headache (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology, PubMed
- A double-blind, randomized, multicenter, Italian study of frovatriptan versus almotriptan for the acute treatment of migraine, PubMed
- Comparative efficacy of eletriptan and zolmitriptan in the acute treatment of migraine, PubMed
- Imitrex Prescribing Information, AccessFDA
- Dr. Brian Staiger, PharmD
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