Nurses Compass
Drug Guide
Eletriptan Hydrobromide
Classification
Therapeutic: Antimigraine Agent
Pharmacological: Serotonin (5-HT) Receptor Agonist (Triptan)
FDA Approved Indications
- Acute treatment of migraine with or without aura
Mechanism of Action
Eletriptan is a selective serotonin receptor agonist (5-HT1B/1D), which causes vasoconstriction of cranial blood vessels and inhibits the release of pro-inflammatory neuropeptides, thereby alleviating migraine symptoms.
Dosage and Administration
Adult: Initially 20 mg taken orally, if response inadequate, may be repeated after 2 hours, maximum 80 mg in 24 hours.
Pediatric: Not approved for pediatric use.
Geriatric: Use with caution; start at lower end of dosing range due to potential increased sensitivity.
Renal Impairment: Adjust dose based on severity; use lower doses in severe impairment.
Hepatic Impairment: Use with caution; start at lower doses and monitor response.
Pharmacokinetics
Absorption: Rapidly absorbed; peak plasma levels in about 1.5 to 2 hours.
Distribution: Widely distributed; high protein binding (~87%).
Metabolism: Primarily hepatic via CYP3A4; minor contributions from CYP2D6.
Excretion: Metabolites excreted mainly in feces and urine.
Half Life: About 4.2 hours.
Contraindications
- History of ischemic heart disease, coronary artery vasospasm, uncontrolled hypertension, or known hypersensitivity to triptans.
Precautions
- Use with caution in patients with risk factors for cardiovascular disease; avoid in patients with hemiplegic or basilar migraine; caution in hepatic impairment; assess for contraindications before use.
Adverse Reactions - Common
- Dizziness (Common)
- Fatigue (Common)
- Dry mouth (Common)
- Nausea (Common)
Adverse Reactions - Serious
- Serious coronary artery vasospasm, myocardial infarction, or arrhythmias (Rare)
- Serotonin syndrome, especially when combined with other serotonergic drugs (Rare)
Drug-Drug Interactions
- Other serotonergic agents (SSRIs, SNRIs, MAOIs), causing increased risk of serotonin syndrome.
- Ergot-containing drugs, due to additive vasoconstrictive effects.
Drug-Food Interactions
N/ADrug-Herb Interactions
N/ANursing Implications
Assessment: Assess for history of cardiovascular disease, hypertension, or other risk factors before administering.
Diagnoses:
- Risk for cardiovascular events related to vasoconstriction.
Implementation: Administer orally with or without food; monitor for adverse effects.
Evaluation: Evaluate for relief of migraine symptoms and monitor for adverse reactions.
Patient/Family Teaching
- Instruct patient to take at first sign of migraine.
- Advise against use if chest pain or tightness occurs.
- Warn about possible dizziness, and advise to avoid driving or operating machinery if affected.
- Discuss the importance of informing healthcare providers about all medications and medical history.
Special Considerations
Black Box Warnings:
- Coronary artery vasospasm, with potential for myocardial ischemia or infarction
Genetic Factors: CYP3A4 inhibitors can increase eletriptan levels, increasing risk of adverse effects.
Lab Test Interference: None reported.
Overdose Management
Signs/Symptoms: Severe vasospasm, chest pain, tightness, arrythmias, or signs of serotonin syndrome.
Treatment: Supportive care; administration of vasodilators such as nitrates if cardiac ischemia suspected; benzodiazepines for agitation or serotonin syndrome.
Storage and Handling
Storage: Store at room temperature, 20°C to 25°C (68°F to 77°F).
Stability: Stable until expiration date when stored properly.