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Chemical Compound Review

Triptane     2,2,3-trimethylbutane

Synonyms: Triptan, AGN-PC-00O9TS, ACMC-1AHI7, AG-F-59538, ANW-30439, ...
 
 
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Disease relevance of Triptan

  • Triptan medications to treat acute migraine [1].
  • Although patients overusing ergots and analgesics typically had a daily tension-type headache, patients with triptan-induced MOH were more likely to describe a (daily) migraine-like headache or an increase in migraine frequency [2].
  • In a mouse model of pneumococcal meningitis, survival and clinical score at 24 hours were significantly improved by triptan treatment [3].
  • In parallel with triptan administration, acting via 5-HT(1B/1D) receptors, head pain subside and neuropeptide release normalise [4].
  • There was no increase in risk of myocardial infarction with current (adjusted RR 0.80, 95% CI 0.58-1.11) or recent (adjusted RR 1.15, 95% CI 0.71-1.87) triptan use [5].
 

Psychiatry related information on Triptan

 

High impact information on Triptan

 

Chemical compound and disease context of Triptan

  • Eletriptan is therefore a useful addition to the triptan family and a first-line treatment option in the acute management of migraine attacks [10].
  • It can be concluded that migraine patients who respond infrequently to sumatriptan should be switched to a different triptan, as lack of response to one triptan does not predict likelihood of responsiveness to another [12].
  • Forty patients with migraine consecutively seen in our clinic were randomized to treat two consecutive moderate or severe attacks with one tablet of 10 mg rizatriptan plus one capsule of 200 mg trimebutine and two attacks with the same triptan and placebo, in counterbalanced order [13].
  • Almotriptan, the new selective 5-HT1B/1D agonist, has a higher oral bioavailability than any other triptan, with more than two thirds of the administered dose absorbed within the first hour both inside and outside of a migraine attack [14].
  • Naratriptan is a newly developed triptan shown to be effective in the treatment of migraine [15].
 

Biological context of Triptan

  • This mechanism may underlie one of the anti-migraine actions of the triptan class exemplified by rizatriptan and suggests that the guinea-pig is an appropriate species in which to investigate the pharmacology of neurogenic dural vasodilation [16].
  • The area under the curves (AUC) during 72 h of untreated attacks was compared with attacks treated with a triptan [17].
  • Patients who had taken a triptan within 3 days prior to the investigation showed platelet activation values similar to the control group [18].
  • In contrast, the increased 5-HT synthesis rate observed after chronic sumatriptan might possibly result from a down-regulation/desensitization of 5-HT1 receptors and/or unmasking of excitatory triptan-sensitive 5-HT receptors [19].
  • OBJECTIVES: To investigate the demographic characteristics associated with triptan use, and examine the rate of co-prescription of triptans with specified pharmacologic agents with the potential for drug interactions [20].
 

Anatomical context of Triptan

 

Associations of Triptan with other chemical compounds

  • Previous studies suggest that calcitonin gene-related peptide (CGRP) released from Adelta-fibres plays a more important role than substance P (SP) released from C-fibres in inducing dural vasodilatation and that one of the antimigraine mechanisms of triptan drugs is inhibiting CGRP release [23].
  • PARTICIPANTS: The Triptan Cardiovascular Safety Expert Panel was composed of a multidisciplinary group of experts in neurology, primary care, cardiology, pharmacology, women's health, and epidemiology [26].
  • CONCLUSIONS: Eletriptan 40 mg provides the best value in terms of the lowest DNT, assuming an approximately equal AWP discount for each triptan [27].
 

Gene context of Triptan

  • Its ability to serve as a substrate for human P-glycoprotein (P-gp) was also investigated since a central mechanism of action has been proposed for this "triptan" class of drug [28].
  • Neural 5-HT1D and/or 5-HT1F receptors localized pre-junctionally on trigeminovascular afferents appear to mediate the triptan-induced inhibition of the neurogenic inflammatory response, with possible additional sites of action for brain penetrant 5-HT1 receptor agonists in inhibiting the transmission of pain centrally [29].
  • Acute treatment with a 5-HT(1B/1D) agonist (triptan) results in alleviation of the headache and normalization of the cranial venous CGRP levels, in part due to a presynaptic inhibitory effect on sensory nerves [30].
  • These factors were 5-HT1B and 5-HT1D receptor activities, the pharmacokinetic elimination half-life of each triptan, and the clinical efficacy of each compound, determined by the proportion of patients with headache relief and the therapeutic gain over placebo [31].
  • Thus, adenoviral gene transfer can be used in trigeminal ganglia neurons for studying the mechanisms of triptan drug action on CGRP synthesis [32].
 

Analytical, diagnostic and therapeutic context of Triptan

References

  1. Triptan medications to treat acute migraine. Kernick, D.P. Lancet (2002) [Pubmed]
  2. Features of medication overuse headache following overuse of different acute headache drugs. Limmroth, V., Katsarava, Z., Fritsche, G., Przywara, S., Diener, H.C. Neurology (2002) [Pubmed]
  3. Triptans reduce the inflammatory response in bacterial meningitis. Hoffmann, O., Keilwerth, N., Bille, M.B., Reuter, U., Angstwurm, K., Schumann, R.R., Dirnagl, U., Weber, J.R. J. Cereb. Blood Flow Metab. (2002) [Pubmed]
  4. Sensory nerves in man and their role in primary headaches. Edvinsson, L. Cephalalgia : an international journal of headache. (2001) [Pubmed]
  5. Severe vascular events in migraine patients. Velentgas, P., Cole, J.A., Mo, J., Sikes, C.R., Walker, A.M. Headache. (2004) [Pubmed]
  6. Successful treatment of status migrainosus after electroconvulsive therapy with dihydroergotamine. Stead, M., Josephs, K.A. Headache. (2005) [Pubmed]
  7. Disruption of communication between peripheral and central trigeminovascular neurons mediates the antimigraine action of 5HT 1B/1D receptor agonists. Levy, D., Jakubowski, M., Burstein, R. Proc. Natl. Acad. Sci. U.S.A. (2004) [Pubmed]
  8. Analgesic triptan action in an animal model of intracranial pain: a race against the development of central sensitization. Burstein, R., Jakubowski, M. Ann. Neurol. (2004) [Pubmed]
  9. Vascular effects of 5-HT1B/1D-receptor agonists in patients with migraine headaches. de Hoon, J.N., Willigers, J.M., Troost, J., Struijker-Boudier, H.A., Van Bortel, L.M. Clin. Pharmacol. Ther. (2000) [Pubmed]
  10. Eletriptan: a review of its use in the acute treatment of migraine. McCormack, P.L., Keating, G.M. Drugs (2006) [Pubmed]
  11. Pharmacokinetics and pharmacodynamics of the triptan antimigraine agents: a comparative review. Jhee, S.S., Shiovitz, T., Crawford, A.W., Cutler, N.R. Clinical pharmacokinetics. (2001) [Pubmed]
  12. Infrequent or non-response to oral sumatriptan does not predict response to other triptans--review of four trials. Dahlöf, C.G. Cephalalgia : an international journal of headache. (2006) [Pubmed]
  13. Rizatriptan vs. rizatriptan plus trimebutine for the acute treatment of migraine: a double-blind, randomized, cross-over, placebo-controlled study. Krymchantowski, A.V., Filho, P.F., Bigal, M.E. Cephalalgia : an international journal of headache. (2006) [Pubmed]
  14. How does almotriptan compare with other triptans? A review of data from placebo-controlled clinical trials. Dahlöf, C.G., Dodick, D., Dowson, A.J., Pascual, J. Headache. (2002) [Pubmed]
  15. Treatment of migraine in Canada with naratriptan: a cost-effectiveness analysis. Caro, J.J., Getsios, D., Raggio, G., Caro, G., Black, L. Headache. (2001) [Pubmed]
  16. The anti-migraine 5-HT(1B/1D) agonist rizatriptan inhibits neurogenic dural vasodilation in anaesthetized guinea-pigs. Williamson, D.J., Hill, R.G., Shepheard, S.L., Hargreaves, R.J. Br. J. Pharmacol. (2001) [Pubmed]
  17. The natural course of migraine attacks. A prospective analysis of untreated attacks compared with attacks treated with a triptan. Linde, M., Mellberg, A., Dahlöf, C. Cephalalgia : an international journal of headache. (2006) [Pubmed]
  18. Platelet activation and platelet-leucocyte interaction in patients with migraine. Subtype differences and influence of triptans. Zeller, J.A., Lindner, V., Frahm, K., Baron, R., Deuschl, G. Cephalalgia : an international journal of headache. (2005) [Pubmed]
  19. Effects of acute or chronic administration of anti-migraine drugs sumatriptan and zolmitriptan on serotonin synthesis in the rat brain. Dobson, C.F., Tohyama, Y., Diksic, M., Hamel, E. Cephalalgia : an international journal of headache. (2004) [Pubmed]
  20. Coprescription of triptans with potentially interacting medications: a cohort study involving 240,268 patients. Tepper, S., Allen, C., Sanders, D., Greene, A., Boccuzzi, S. Headache. (2003) [Pubmed]
  21. Treatment-emergent CNS symptoms following triptan therapy are part of the attack. Goadsby, P., Dodick, D., Almas, M., Diener, H.C., Tfelt-Hansen, P., Lipton, R., Parsons, B. Cephalalgia : an international journal of headache (2007) [Pubmed]
  22. No contractile effect for 5-HT1D and 5-HT1F receptor agonists in human and bovine cerebral arteries: similarity with human coronary artery. Bouchelet, I., Case, B., Olivier, A., Hamel, E. Br. J. Pharmacol. (2000) [Pubmed]
  23. Colocalization of CGRP with 5-HT1B/1D receptors and substance P in trigeminal ganglion neurons in rats. Ma, Q.P., Hill, R., Sirinathsinghji, D. Eur. J. Neurosci. (2001) [Pubmed]
  24. Effects of chronic sumatriptan and zolmitriptan treatment on 5-HT receptor expression and function in rats. Reuter, U., Salomone, S., Ickenstein, G.W., Waeber, C. Cephalalgia : an international journal of headache. (2004) [Pubmed]
  25. Involvement of 5-HT1B receptors in triptan-induced contractile responses in guinea-pig isolated iliac artery. Jähnichen, S., Radtke, O.A., Pertz, H.H. Naunyn Schmiedebergs Arch. Pharmacol. (2004) [Pubmed]
  26. Consensus statement: cardiovascular safety profile of triptans (5-HT agonists) in the acute treatment of migraine. Dodick, D., Lipton, R.B., Martin, V., Papademetriou, V., Rosamond, W., MaassenVanDenBrink, A., Loutfi, H., Welch, K.M., Goadsby, P.J., Hahn, S., Hutchinson, S., Matchar, D., Silberstein, S., Smith, T.R., Purdy, R.A., Saiers, J. Headache. (2004) [Pubmed]
  27. Triptans for migraine therapy: a comparison based on number needed to treat and doses needed to treat. Mullins, C.D., Weis, K.A., Perfetto, E.M., Subedi, P.R., Healey, P.J. Journal of managed care pharmacy : JMCP. (2005) [Pubmed]
  28. Eletriptan metabolism by human hepatic CYP450 enzymes and transport by human P-glycoprotein. Evans, D.C., O'Connor, D., Lake, B.G., Evers, R., Allen, C., Hargreaves, R. Drug Metab. Dispos. (2003) [Pubmed]
  29. The biology of serotonin receptors: focus on migraine pathophysiology and treatment. Hamel, E. The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques. (1999) [Pubmed]
  30. Blockade of CGRP receptors in the intracranial vasculature: a new target in the treatment of headache. Edvinsson, L. Cephalalgia : an international journal of headache. (2004) [Pubmed]
  31. Migraine headache recurrence: relationship to clinical, pharmacological, and pharmacokinetic properties of triptans. Géraud, G., Keywood, C., Senard, J.M. Headache. (2003) [Pubmed]
  32. Neuronal expression and regulation of CGRP promoter activity following viral gene transfer into cultured trigeminal ganglia neurons. Durham, P.L., Dong, P.X., Belasco, K.T., Kasperski, J., Gierasch, W.W., Edvinsson, L., Heistad, D.D., Faraci, F.M., Russo, A.F. Brain Res. (2004) [Pubmed]
  33. Oral triptans (serotonin 5-HT(1B/1D) agonists) in acute migraine treatment: a meta-analysis of 53 trials. Ferrari, M.D., Roon, K.I., Lipton, R.B., Goadsby, P.J. Lancet (2001) [Pubmed]
  34. Evaluating the triptans. Mathew, N.T., Loder, E.W. Am. J. Med. (2005) [Pubmed]
  35. Triptans and chest symptoms: the role of pulmonary vasoconstriction. Dodick, D.W. Cephalalgia : an international journal of headache. (2004) [Pubmed]
  36. Double-blind clinical trials of oral triptans vs other classes of acute migraine medication - a review. Lipton, R.B., Bigal, M.E., Goadsby, P.J. Cephalalgia : an international journal of headache. (2004) [Pubmed]
 
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