Migraine and headache:
Indications for MAXALT-MLT:
Acute treatment of migraine.
≥18yrs: Initially 5 or 10mg; may repeat after 2 hrs; max 30mg/day. Concomitant propranolol: use 5mg dose; max 3 doses/day. The safety of treating, on average, more than 4 headaches in a 30-day period has not been established.
<18yrs: not recommended.
Ischemic heart disease (eg, angina pectoris, history of MI, documented silent ischemia). Coronary artery vasospasm (eg, Prinzmetal's angina). Uncontrolled hypertension. Other significant cardiovascular disease. Basilar or hemiplegic migraine. Within 24 hours of other 5-HT1 agonists or ergot-type drugs. During or within 2 weeks after discontinuing MAOIs.
Confirm diagnosis. Reevaluate if angina or ischemia symptoms (eg, ischemic bowel syndrome) occur, or if no response after 1st dose. Exclude underlying cardiovascular disease, supervise 1st dose, and consider monitoring ECG in patients with likelihood of unrecognized coronary disease (eg, post-menopausal women, men over age 40, hypertension, hypercholesterolemia, obesity, diabetes, smokers, strong family history). Monitor cardiovascular function in long-term intermittent use. Peripheral vascular or colonic ischemia following other 5-HT1 agonists. Hepatic dysfunction. Dialysis. Pregnancy (Cat.C). Nursing mothers.
Selective 5-HT1B/1D receptor agonist.
MAOIs, methysergide, other ergotamines, or other 5-HT1 agonists: see Contraindications. Caution with SSRIs. Exposure increased by propranolol.
Asthenia, somnolence, dizziness, paresthesia, chest/jaw/throat pressure or other pain, dry mouth, nausea, headache; serious cardiac events (rare).