Rx Update: May 2003
Mary Ross, R.Ph., M.B.A., Joan Murhammer, R.Ph., Kevin Bebout,
R. Ph.
First Published: May 2003
Last Revised: May 2003
Peer Review Status: Internally Reviewed
Almotriptan
Almotriptan (Axert®) is a selective serotonin (5-HT1) receptor agonist indicated for the acute treatment of migraine with or without aura. It is not indicated for the prophylactic therapy of migraine or in the treatment of hemiplegic or basilar migraines.
Almotriptan should not be administered to patients with ischemic or vasospastic coronary artery disease because of its potential to cause coronary vasospasm. Almotriptan should not be given to patients in whom unrecognized coronary artery disease (CAD) is predicted by the presence of risk factors (e.g., hypertension, hypercholesterolemia, smoker, obesity, diabetes, strong family history of CAD, female with surgical or physiological menopause, or male over 40 years of age) unless a cardiovascular evaluation provides satisfactory clinical evidence that the patient is free of significant underlying cardiovascular disease.
Almotriptan should not be given to patients with uncontrolled hypertension because of its potential to increase blood pressure. Almotriptan is contraindicated within 24 hours of treatment with another 5-HT1 agonist (e.g., sumatriptan, naratriptan, rizatriptan, zolmitriptan) or ergotamine-containing or ergot-type medication (e.g., dihydroergotamine, methysergide).
The most common adverse effects during almotriptan therapy are nausea, somnolence, headache, paresthesia, and dry mouth. Sensations of tightness, pain, pressure, and heaviness in the precordium, throat, neck, and jaw have also been reported. Serious cardiac events, including myocardial infarction and coronary artery vasospasm have rarely occurred following almotriptan therapy.
The recommended dose of almotriptan in adults is 6.25 to 12.5 mg. If the headache returns, the dose may be repeated after 2 hours, but no more than two doses should be given in a 24-hour period. The recommended dose of almotriptan in patients with renal or liver impairment is 6.25 mg with a daily maximum dose of 12.5 mg per 24-hour period.
Almotriptan is available as 6.25 and 12.5 mg tablets.
Adult and Pediatric Antibiotic Dose Standardization
Pharmacy and Therapeutics Subcommittee policy encourages the use of antibiotic dose standardization as a method to reduce the risk of dosing errors and help to reduce waste. The pharmacy automatically converts any non-standard antibiotic doses to standard doses for all intravenous antibiotics that are listed on the approved dose standardization chart.
The adult and pediatric (>20 Kg) antibiotic dose standardization charts have been revised. Both charts are available in the UIHC Formulary and Handbook under the Formulary Table of Contents, Pharmacy and Therapeutics Subcommittee Policies (www.vh.org/formulary/Form/04Parenteral.html and www.vh.org/formulary/Form/05PedParenteral.html). The adult version is also part of a physician communication form (Form 602b).