Back To Search Results


Editor: Priti Patel Updated: 9/21/2022 10:00:47 AM

Almotriptan is the first FDA-approved drug used to treat migraine headaches in adults with or without an aura.[1] The drug is also useful in adolescents with a history of a migraine that, when left untreated, lasts 4 hours or longer. Certain triptan medications such as almotriptan and rizatriptan have also been shown to be effective and safe for managing acute migraines and other benign headaches in the pediatric population (less than 18 years of age).[2] 

Almotriptan has approval for use as monotherapy and in conjunction with migraine-abortive medications such as non-steroidal anti-inflammatory drugs (e.g., aceclofenac).[3] It is usually taken by mouth as a tablet.[4] Almotriptan is a white, coated circular tablet and requires a prescription from a registered physician in the United States.[5] 

A randomized, double-blind study by Pascual J. et al. examined the therapeutic efficacy and side effect profile of almotriptan. It was given as a single dose of 6.25 mg or 12.5 mg, and it was compared with placebo in patients with three consecutive migraine episodes of moderate to severe presentation. Seven hundred twenty-two patients completed the study out of 1013 initially enrolled. Almotriptan was found to be superior to placebo in reducing the migraine pain from moderate-severe to mild-no pain at 2 hours after the dose, i.e., 60% (6.25 mg) and 70% (12.5 mg) vs. 38% (placebo). There appeared to be no clinically significant differences in side effects between the almotriptan-treated patients compared with placebo. The study recommends a dose of 12.5 mg to treat migraines because the risk/benefit ratio is optimal at this dose.[6]

A randomized double-blinded study by Dalof C. et al. examined the therapeutic efficacy and side effect profile of almotriptan. It was given as a single dose of 2 mg, 6.25 mg, 12.5 mg, or 25 mg, and it was compared with placebo in patients with moderate to severe migraine pain intensity. Seven hundred forty-two patients completed the study out of 903 initially enrolled. Almotriptan was found to be superior to placebo in reducing the migraine pain at doses above 2 mg at 2 hours after dose, i.e., 30% (2 mg), 56.3% (6.25 mg), 58.5% (12.5 mg), 66.5% (25 mg) vs. 32.5% (placebo). There appeared to be no clinically important differences in side effects between the almotriptan-treated patients at doses of 2 mg, 6.25 mg, and 12.5 mg compared with placebo. The study recommends a dose of 12.5 mg to treat migraines because the risk/benefit ratio is optimal at this dose, and the 6.25 mg dose demonstrated a minimum effective dose.[7]

A double-blind comparison study by Spierings L. et al. examined the therapeutic efficacy (24-hour abortive treatment) and side effect profiles of almotriptan vs. sumatriptan which is an older anti-migraine medication commonly used in comparison studies. Almotriptan was given at a dose of 12.5 mg, and sumatriptan was given at a dose of 50 mg in patients with moderate to severe migraines. The oral capsules of each medication appeared identical to ensure blinding of patients and investigators. One thousand one hundred seventy-three patients received either almotriptan (591) or sumatriptan (582). Almotriptan was found to be similar to sumatriptan in reducing migraine pain 58.0% vs. 57.3%, respectively. Rescue medications were taken by patients in the almotriptan treatment arm 36.7% and 33.2% in the sumatriptan treatment arm. Moderate to severe intensity migraines returned in almotriptan and sumatriptan-treated patients 27.4% vs. 24.0%, respectively. Side effects appeared in 15.2 % of almotriptan-treated patients and 19.4% sumatriptan-treated patients. A potentially significant side effect of chest pain occurred at a higher rate in sumatriptan-treated patients vs. almotriptan-treated patients, 2.2% vs. 0.3%, respectively. The study concluded that almotriptan was similar to sumatriptan in therapeutic efficacy and side effect profiles.[8]

In pregnant women with migraines or headaches, triptan use is less frequent, whereas drugs like metoclopramide and acetaminophen are more common choices for migraines due to their effectiveness and safety.[9] Triptans have also been quite effective in treating menstrual migraines in premenopausal women. Various studies have shown that rizatriptan has proven to be the most beneficial in treating acute menstrual migraines in females among triptan drugs.[10] A randomized, placebo-controlled study showed that rizatriptan provided pain relief between 2 to 24 hours with an efficacy of 63 percent when compared to other triptans.[10] 

Mechanism of Action

Earn CME credit as you help guide your clinical decisions.
Get the answers you need instantly with the StatPearls Clinical Decision Support tool. StatPearls spent the last decade developing the largest and most updated Point-of Care resource ever developed.


$59 per month


$599 per year

Almotriptan is a selective serotonin agonist on the 5-HT1B and 5-HT1D receptors in the cranial arteries. Activation of the 5HT receptors is associated with reducing neurogenic inflammation, which researchers hypothesize to be involved in the migraine relief process.

Almotriptan works by narrowing the blood vessels in the brain, thereby reducing the cerebral blood flow stopping the transmission of pain signals to the brain center.[11] The drug has a relatively short half-life of 3 hours, and the oral bioavailability was found to be 69.1%.[12] Almotriptan is excreted in the urine and metabolized predominantly by the cytochrome CYP450 system.[12] Compared with earlier generation triptans such as sumatriptan, almotriptan has a higher oral bioavailability and a shorter plasma half-life.[11]

The recommended oral dose of almotriptan is 12.5 mg to treat acute migraine attacks in adults and adolescents effectively.[12] The dose may be repeated after two hours if a headache returns. It is recommended not to administer more than two doses or more than 25 mg/day. Studies have also shown that almotriptan has a synergistic effect when combined with aceclofenac 100 mg to treat an acute migraine attack.[3] 

Food intake has not demonstrated any effect on the absorption of almotriptan; therefore, its dosing can be without regard to food intake.[12] Dosing adjustment is recommended in patients with renal insufficiency. Dosing adjustment is necessary when the drug is used with cytochrome P450 inducers (e.g., phenytoin, phenobarbital) and cytochrome P450 inhibitors (e.g., certain antimicrobials, grapefruit juice, ketoconazole, protease inhibitors). 

The common adverse effects of almotriptan are drowsiness, dizziness, headache, nausea, vomiting, chest pain, and fatigue.[13] The drug is associated with a similar incidence of nausea/vomiting compared to other classes of triptans (e.g., sumatriptan). However, it shows a decreased incidence of the other common adverse effects listed above, especially when compared to first-generation triptans.[11][13] 

Almotriptan binds to 5HT1B receptors, which are present in the coronary arteries; thus, the administration may result in coronary artery narrowing or spasms, leading to potential coronary artery vasospasm or myocardial infarction.[14] Some rare side effects of almotriptan include pulmonary vasoconstriction, serotonin syndrome, inhibition of trigeminal nerves.[15][16]

Almotriptan is contraindicated in patients with renal dysfunction or insufficiency and the elderly due to a physiological decrease in renal function and renal clearance with advanced age.[12] 

Minor clearance of almotriptan occurs through the CYP450 system (specifically, CYP3A4); therefore, the clinician should avoid other drugs metabolized through this pathway because they may decrease almotriptan clearance. These drugs include but are not limited to verapamil, nifedipine, losartan, cyclosporine, and moclobemide.[12] It is reasonable to assume that patients with decreased activity of this enzyme should be cautious in dosing the drug.

Contraindications to almotriptan also include patients with underlying cardiovascular disease due to the presence of 5HT1B receptors on the coronary arteries. Almotriptan potentially binds to such receptors resulting in further narrowing or spasm of the arteries.[14] Patients with hypersensitivity to almotriptan should not use the drug, nor should patients with a history of a hemiplegic or basilar migraine or a heart condition. Moreover, this medication is not for use in patients with cerebrovascular syndromes, peripheral vascular disease, or high blood pressure. Caution is necessary if dosing almotriptan within 24 hours of using a serotonin agonist or an ergotamine class medication due to the vasoconstrictive effects of both drugs.[16] 

Patients taking almotriptan should require monitoring for the presence of side effects and response to therapy. Kidney function should be monitored when taking the drug as renal clearance may affect the overall drug clearance from the body, causing toxicity. Regular monitoring of the blood pressure should occur at each clinical visit due to the narrowing effect of the 5-HT1B receptors on the blood vessels and assess the effectiveness of the drug.[16] 


There are no associated toxicities with almotriptan due to the limited data, although studies demonstrate increased preterm birth rates in pregnant women that received triptans for migraine relief.[17]

An analysis of several case reports of patients undergoing dual triptan-SSRI/SNRI, e.g., fluoxetine and venlafaxine, therapy or triptan monotherapy, suggested adding triptans to SSRI/SNRI therapy does not necessarily increase patients' risk of developing serotonin syndrome. However, providers should remain cautious and vigilant of the symptoms.[18]

Enhancing Healthcare Team Outcomes

Managing the administration of almotriptan in patients with acute migraines requires an interprofessional team of healthcare professionals that include a neurologist, primary care physician, nephrologist in the case of a compromised renal function, psychiatrist, specialty-trained nursing staff, and pharmacist for appropriate dosing and safety precautions, all working collaboratively to ensure optimal patient outcomes. Nurses must be ready to inform the prescriber regarding any potential adverse events from the medication and monitor whether almotriptan provides adequate migraine pain relief. The pharmacist must look into possible drug-drug interactions, verify dosing, counsel the patient on proper administration, and answer patient questions regarding the safe use of the drug. A robust support system consisting of the patients' family and friends may also contribute to successful health outcomes.

Consistent patient follow-up and adherence to appointment times are essential for properly monitoring vital signs and managing any adverse effects. Moreover, it is also necessary for assessing drug effectiveness. This type of interprofessional team effort is essential to optimize therapy with almotriptan so the patient can achieve the best outcomes. [Level 5]



Eiland LS, Hunt MO. The use of triptans for pediatric migraines. Paediatric drugs. 2010 Dec 1:12(6):379-89. doi: 10.2165/11532860-000000000-00000. Epub     [PubMed PMID: 21028917]


Patniyot IR, Gelfand AA. Acute Treatment Therapies for Pediatric Migraine: A Qualitative Systematic Review. Headache. 2016 Jan:56(1):49-70. doi: 10.1111/head.12746. Epub     [PubMed PMID: 26790849]

Level 2 (mid-level) evidence


Schoenen J, De Klippel N, Giurgea S, Herroelen L, Jacquy J, Louis P, Monseu G, Vandenheede M, Belgian Headache Society. Almotriptan and its combination with aceclofenac for migraine attacks: a study of efficacy and the influence of auto-evaluated brush allodynia. Cephalalgia : an international journal of headache. 2008 Oct:28(10):1095-105. doi: 10.1111/j.1468-2982.2008.01654.x. Epub 2008 Jul 17     [PubMed PMID: 18644036]


Dowson AJ. Oral almotriptan: practical uses in the acute treatment of migraine. Expert review of neurotherapeutics. 2004 May:4(3):339-48     [PubMed PMID: 15853532]


Sharma M, Vadhariya A, Johnson ML, Marcum ZA, Holmes HM. Association between industry payments and prescribing costly medications: an observational study using open payments and medicare part D data. BMC health services research. 2018 Apr 2:18(1):236. doi: 10.1186/s12913-018-3043-8. Epub 2018 Apr 2     [PubMed PMID: 29609611]

Level 2 (mid-level) evidence


Pascual J, Falk RM, Piessens F, Prusinski A, Docekal P, Robert M, Ferrer P, Luria X, Segarra R, Zayas JM. Consistent efficacy and tolerability of almotriptan in the acute treatment of multiple migraine attacks: results of a large, randomized, double-blind, placebo-controlled study. Cephalalgia : an international journal of headache. 2000 Jul:20(6):588-96     [PubMed PMID: 11075844]

Level 1 (high-level) evidence


Dahlöf C, Tfelt-Hansen P, Massiou H, Fazekas A, Almotriptan Study Group. Dose finding, placebo-controlled study of oral almotriptan in the acute treatment of migraine. Neurology. 2001 Nov 27:57(10):1811-7     [PubMed PMID: 11723269]


Spierings EL, Gomez-Mancilla B, Grosz DE, Rowland CR, Whaley FS, Jirgens KJ. Oral almotriptan vs. oral sumatriptan in the abortive treatment of migraine: a double-blind, randomized, parallel-group, optimum-dose comparison. Archives of neurology. 2001 Jun:58(6):944-50     [PubMed PMID: 11405809]

Level 1 (high-level) evidence


Hamilton KT, Robbins MS. Migraine Treatment in Pregnant Women Presenting to Acute Care: A Retrospective Observational Study. Headache. 2019 Feb:59(2):173-179. doi: 10.1111/head.13434. Epub 2018 Nov 7     [PubMed PMID: 30403400]

Level 2 (mid-level) evidence


Maasumi K, Tepper SJ, Kriegler JS. Menstrual Migraine and Treatment Options: Review. Headache. 2017 Feb:57(2):194-208. doi: 10.1111/head.12978. Epub 2016 Dec 2     [PubMed PMID: 27910087]


Kassem AA. Formulation Approaches of Triptans for Management of Migraine. Current drug delivery. 2016:13(6):882-98     [PubMed PMID: 27109335]


McEnroe JD, Fleishaker JC. Clinical pharmacokinetics of almotriptan, a serotonin 5-HT(1B/1D) receptor agonist for the treatment of migraine. Clinical pharmacokinetics. 2005:44(3):237-46     [PubMed PMID: 15762767]


Thorlund K, Toor K, Wu P, Chan K, Druyts E, Ramos E, Bhambri R, Donnet A, Stark R, Goadsby PJ. Comparative tolerability of treatments for acute migraine: A network meta-analysis. Cephalalgia : an international journal of headache. 2017 Sep:37(10):965-978. doi: 10.1177/0333102416660552. Epub 2016 Aug 12     [PubMed PMID: 27521843]

Level 2 (mid-level) evidence


Tepper SJ, Millson D. Safety profile of the triptans. Expert opinion on drug safety. 2003 Mar:2(2):123-32     [PubMed PMID: 12904112]

Level 3 (low-level) evidence


Dodick DW. Triptans and chest symptoms: the role of pulmonary vasoconstriction. Cephalalgia : an international journal of headache. 2004 Apr:24(4):298-304     [PubMed PMID: 15030540]


Tepper SJ, Rapoport AM, Sheftell FD. Mechanisms of action of the 5-HT1B/1D receptor agonists. Archives of neurology. 2002 Jul:59(7):1084-8     [PubMed PMID: 12117355]


Soldin OP, Dahlin J, O'Mara DM. Triptans in pregnancy. Therapeutic drug monitoring. 2008 Feb:30(1):5-9. doi: 10.1097/FTD.0b013e318162c89b. Epub     [PubMed PMID: 18223456]


Shader RI, Greenblatt DJ. Is There Always a Right or Wrong?: Comments on the FDA Warnings About Triptans and the Serotonin Syndrome. Journal of clinical psychopharmacology. 2018 Dec:38(6):545-546. doi: 10.1097/JCP.0000000000000965. Epub     [PubMed PMID: 30303862]

Level 3 (low-level) evidence


. Almotriptan. Drugs and Lactation Database (LactMed®). 2006:():     [PubMed PMID: 30000519]


Pascual J, Vila C. Almotriptan: a review of 20 years' clinical experience. Expert review of neurotherapeutics. 2019 Aug:19(8):759-768. doi: 10.1080/14737175.2019.1591951. Epub 2019 Mar 21     [PubMed PMID: 30845850]


Nair AB, Al-Dhubiab BE, Shah J, Jacob S, Saraiya V, Attimarad M, SreeHarsha N, Akrawi SH, Shehata TM. Mucoadhesive buccal film of almotriptan improved therapeutic delivery in rabbit model. Saudi pharmaceutical journal : SPJ : the official publication of the Saudi Pharmaceutical Society. 2020 Feb:28(2):201-209. doi: 10.1016/j.jsps.2019.11.022. Epub 2019 Dec 7     [PubMed PMID: 32042259]


Singh RBH, VanderPluym JH, Morrow AS, Urtecho M, Nayfeh T, Roldan VDT, Farah MH, Hasan B, Saadi S, Shah S, Abd-Rabu R, Daraz L, Prokop LJ, Murad MH, Wang Z. Acute Treatments for Episodic Migraine. 2020 Dec:():     [PubMed PMID: 33411427]