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Axert (almotriptan) Disease Interactions

There are 4 disease interactions with Axert (almotriptan):

Major

5-Ht1 Agonists (Includes Axert) ↔ Cad Risk Factors

Severe Potential Hazard, High plausibility

Applies to: Hyperlipidemia, Smoking, Obesity, Diabetes Mellitus, History (Familial) - Ischemic Heart Disease, Menopausal Disorders

The group of drugs known as 5-hydroxytryptamine1 receptor (5-HT1) agonists can cause vasospastic reactions, including coronary vasospasm, peripheral vascular ischemia, and colonic ischemia. Rarely, serious adverse cardiac events including acute myocardial infarction, arrhythmia, cardiac arrest, and death have been reported within a few hours following the administration of 5-HT1 agonists, in some cases even in patients with no prior history or findings of coronary artery disease (CAD). Significant elevation in blood pressure, including hypertensive crisis, has also been reported on rare occasions in patients with and without a history of hypertension, as have transient increases in blood pressure and peripheral vascular resistance. In general, patients with potentially unrecognized CAD as predicted by the presence of risk factors (e.g., hypertension, hypercholesterolemia, tobacco use, obesity, diabetes, strong family history of CAD, female with surgical or physiological menopause, or male over 40 years of age) should not be administered 5-HT1 agonists unless a cardiovascular evaluation provides satisfactory clinical evidence indicating the lack of CAD, ischemic heart disease, or other significant underlying cardiovascular disease. As a precaution, the manufacturers recommend that the first dose be administered under medical surveillance in such patients, and that electrocardiographic monitoring be considered during the interval immediately following administration to help detect any asymptomatic cardiac ischemia that may occur. Periodic cardiovascular evaluations should be performed during intermittent, long-term use.

References

  1. Mueller L, Gallagher RM, Ciervo CA "Vasospasm-induced myocardial infarction with sumatriptan." Headache 36 (1996): 329-31
  2. Kelly KM "Cardiac arrest following use of sumatriptan." Neurology 45 (1995): 1211-3
  3. "Product Information. Axert (almotriptan)" Pharmacia and Upjohn, Kalamazoo, MI.
View all 23 references
Major

5-Ht1 Agonists (Includes Axert) ↔ Cardiovascular Disease

Severe Potential Hazard, High plausibility

Applies to: Cardiovascular Disease, History - Myocardial Infarction, Cerebral Vascular Disorder, History - Cerebrovascular Disease

The use of 5-hydroxytryptamine1 receptor (5-HT1) agonists is contraindicated in patients with a current or past history of ischemic cardiac, cerebrovascular, and/or peripheral vascular diseases. In addition, these agents should not be used in patients with significant underlying cardiovascular diseases or uncontrolled hypertension. 5-HT1 agonists can cause vasospastic reactions, including coronary vasospasm, peripheral vascular ischemia, and colonic ischemia. Rarely, serious adverse cardiac events including acute myocardial infarction, arrhythmia, cardiac arrest, and death have been reported within a few hours following the administration of 5-HT1 agonists, in some cases even in patients with no prior history or findings of coronary artery disease (CAD). Significant elevation in blood pressure, including hypertensive crisis, has also been reported on rare occasions in patients with and without a history of hypertension, as have transient increases in blood pressure and peripheral vascular resistance. Cerebrovascular events have included cerebral hemorrhage, subarachnoid hemorrhage, and stroke, some resulting in fatalities. However, the relationship to 5-HT1 agonists is uncertain and, in a number of cases, the cerebrovascular events may have been primary where symptoms were mistaken to be migraine.

References

  1. Ottervanger JP, Paalman HJ, Boxma GL, Stricker BH "Transmural myocardial infarction with sumatriptan." Lancet 341 (1993): 861-2
  2. Kelly KM "Cardiac arrest following use of sumatriptan." Neurology 45 (1995): 1211-3
  3. "Product Information. Axert (almotriptan)" Pharmacia and Upjohn, Kalamazoo, MI.
View all 23 references
Major

Almotriptan (Includes Axert) ↔ Liver Disease

Severe Potential Hazard, High plausibility

Applies to: Liver Disease

Almotriptan is partially metabolized by the liver. The pharmacokinetics of almotriptan have not been assessed in patients with hepatic impairment. Based on the known mechanisms of clearance of almotriptan, the maximum decrease in clearance expected due to hepatic impairment would be 60%. The manufacturer recommends that a starting dose of 6.25 mg be used in patients with significantly impaired hepatic function, and that the maximum dosage not exceed 12.5 mg per 24-hour period.

References

  1. "Product Information. Axert (almotriptan)" Pharmacia and Upjohn, Kalamazoo, MI.
Major

Almotriptan (Includes Axert) ↔ Renal Dysfunction

Severe Potential Hazard, High plausibility

Applies to: Renal Dysfunction

Approximately 40% of an administered dose of almotriptan is excreted unchanged in the urine. Following oral administration in patients with renal impairment, the clearance of almotriptan was approximately 65% lower in patients with severe impairment (CrCl = 10 to 30 mL/min) and 40% lower in patients with moderate impairment (CrCl = 31 to 71 mL/min) compared to healthy controls. Peak plasma concentrations of almotriptan increased by approximately 80% in these patients. The manufacturer recommends that a starting dose of 6.25 mg be used in patients with significantly impaired renal function, and that the maximum dosage not exceed 12.5 mg per 24-hour period.

References

  1. "Product Information. Axert (almotriptan)" Pharmacia and Upjohn, Kalamazoo, MI.

Axert (almotriptan) drug Interactions

There are 107 drug interactions with Axert (almotriptan)

Axert (almotriptan) alcohol/food Interactions

There are 2 alcohol/food interactions with Axert (almotriptan)

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.

Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.

Do not stop taking any medications without consulting your healthcare provider.

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