Comparison Of 'Triptan' Drugs

In our latest question and answer, the pharmacist compares all of the available 'Triptan' drugs and provides a comparison chart.

Question

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?

Asked by Wilson On Nov 23, 2022

Answered by
Medical Content Reviewed By HelloPharmacist Staff

Published Nov 23, 2022
Last updated Nov 24, 2022

Key points

  • 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.

Answer

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 NameDosage RangeMinimum Time Between DosesMax Dose/24 Hours% Experiencing Pain Relief at 2 HoursOnset Of ActionTime To Max ConcentrationHalf-LifeComments
AlmotriptanAxert
Adults: 6.25 to 12.5 mg, may repeat dose in 2 hours
2 Hours25mgAdults: 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 hoursFDA-approved for the acute treatment of migraine in children or adolescents
Eletriptan
Relpax20 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 hoursn/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
Amerge1 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 hoursTriptan 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
Imitrex5 to 20 mg INTRANASALLY, may repeat dose in 2 hours
2 Hours
200 mg52% (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; Alsuma1 to 6 mg (Imitrex), 4 or 6 mg (Sumavel DosePro), or 6 mg (Alsuma), may repeat after 1 hour
1 Hour12 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/a13 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 ZMT1.25 (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
ZomigNasal 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.

Concerns

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.
Neurology . 2004 Feb 24;62(4):563-8

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.

Final Words

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!

References

  • 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

About the Pharmacist

Dr. Brian Staiger, PharmD

Dr. Brian has been practicing pharmacy for over 11 years and has wide-ranging experiences in many different areas of the profession. From retail, clinical and administrative responsibilities, he's your knowledgeable and go-to source for all your pharmacy and medication-related questions! Feel free to send him an email at Hello@HelloPharmacist.com! You can also connect with Dr. Brian Staiger on LinkedIn.

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