Eletriptan, sold under the brand name Relpax and used in the form of eletriptan hydrobromide, is a second generation
triptan
Triptans are a family of tryptamine-based drugs used as abortive medication in the treatment of migraines and cluster headaches. This drug class was first commercially introduced in the 1990s. While effective at treating individual headaches, th ...
medication
A medication (also called medicament, medicine, pharmaceutical drug, medicinal drug or simply drug) is a drug used to diagnose, cure, treat, or prevent disease. Drug therapy (pharmacotherapy) is an important part of the medical field and re ...
intended for treatment of
migraine
Migraine (, ) is a common neurological disorder characterized by recurrent headaches. Typically, the associated headache affects one side of the head, is pulsating in nature, may be moderate to severe in intensity, and could last from a few hou ...
headache
Headache is the symptom of pain in the face, head, or neck. It can occur as a migraine, tension-type headache, or cluster headache. There is an increased risk of depression in those with severe headaches.
Headaches can occur as a result ...
s.
It is used as an
abortive medication
A therapy or medical treatment (often abbreviated tx, Tx, or Tx) is the attempted remediation of a health problem, usually following a medical diagnosis.
As a rule, each therapy has indications and contraindications. There are many different ...
, blocking a migraine attack which is already in progress. Eletriptan is marketed and manufactured by
Pfizer Inc
Pfizer Inc. ( ) is an American multinational pharmaceutical and biotechnology corporation headquartered on 42nd Street in Manhattan, New York City. The company was established in 1849 in New York by two German entrepreneurs, Charles Pfizer ...
.
Approval and availability
Eletriptan was approved by the US
Food and Drug Administration
The United States Food and Drug Administration (FDA or US FDA) is a List of United States federal agencies, federal agency of the United States Department of Health and Human Services, Department of Health and Human Services. The FDA is respon ...
(FDA) on December 26, 2002, for the acute treatment of migraine with or without
aura in adults.
It is available only by
prescription in the United States and Canada. It is not intended for the prophylactic therapy of migraine or for use in the management of hemiplegic or basilar migraine. It is available in 20 mg and 40 mg strengths.
Eletriptan was covered by
[ and ;][ both now expired.
]
Mechanism of action
Eletriptan is believed to reduce swelling of the blood vessels surrounding the brain. This swelling is associated with the head pain of a migraine attack. Eletriptan blocks the release of substances from nerve endings that cause more pain and other symptoms like nausea, and sensitivity to light and sound. It is thought that these actions contribute to relief of symptoms by eletriptan.
Eletriptan is a serotonin receptor agonist
A serotonin receptor agonist is an agonist of one or more serotonin receptors. They activate serotonin receptors in a manner similar to that of serotonin (5-hydroxytryptamine; 5-HT), a neurotransmitter and hormone and the endogenous ligand of the ...
, specifically an agonist
An agonist is a chemical that activates a receptor to produce a biological response. Receptors are cellular proteins whose activation causes the cell to modify what it is currently doing. In contrast, an antagonist blocks the action of the ago ...
of certain 5-HT1 family receptors. Eletriptan binds with high affinity to the 5-HT 1D,_ 1D,_ 1F/sub>.html"_;"title="5-HT1F.html"_;"title="5-HT1D.html"_;"title="B,_5-HT1D">1D,_5-HT1F">1F/sub>">5-HT1F.html"_;"title="5-HT1D.html"_;"title="B,_5-HT1D">1D,_5-HT1F">1F/sub>_receptors._It_has_a_modest_affinity_to_the_ 1F/sub>.html"_;"title="5-HT1F.html"_;"title="5-HT1D.html"_;"title="B,_5-HT1D">1D,_5-HT1F">1F/sub>">5-HT1F.html"_;"title="5-HT1D.html"_;"title="B,_5-HT1D">1D,_5-HT1F">1F/sub>_receptors._It_has_a_modest_affinity_to_the_5-HT1A">5-HT[1A,_ 1F/sub>.html"_;"title="5-HT1F.html"_;"title="5-HT1D.html"_;"title="B,_5-HT1D">1D,_5-HT1F">1F/sub>">5-HT1F.html"_;"title="5-HT1D.html"_;"title="B,_5-HT1D">1D,_5-HT1F">1F/sub>_receptors._It_has_a_modest_affinity_to_the_5-HT1A">5-HT[1A,_5-HT1E">1E,_ 1F/sub>.html"_;"title="5-HT1F.html"_;"title="5-HT1D.html"_;"title="B,_5-HT1D">1D,_5-HT1F">1F/sub>">5-HT1F.html"_;"title="5-HT1D.html"_;"title="B,_5-HT1D">1D,_5-HT1F">1F/sub>_receptors._It_has_a_modest_affinity_to_the_5-HT1A">5-HT[1A,_5-HT1E">1E,_5-HT2B_receptor">2B,_5-HT7.html" ;"title="5-HT2B_receptor.html" ;"title="5-HT1E.html" ;"title="5-HT1A.html" ;"title="5-HT1F">1F/sub>.html" ;"title="5-HT1F.html" ;"title="5-HT1D.html" ;"title="B, 5-HT1D">1D, 5-HT1F">1F/sub>">5-HT1F.html" ;"title="5-HT1D.html" ;"title="B, 5-HT1D">1D, 5-HT1F">1F/sub> receptors. It has a modest affinity to the 5-HT1A">5-HT[1A, 5-HT1E">1E, 5-HT2B receptor">2B, 5-HT7">7/sub> receptors, and little to no affinity at the 5-HT2A, 5-HT[2A, 5-HT2C receptor, 2C, 5-HT3, 3, 5-HT4, 4, 5A, 6/sub> receptors.
Eletriptan has no significant affinity or pharmacological activity at adrenergic receptor, adrenergic α1, α2, or β; dopaminergic
Dopaminergic means "related to dopamine" (literally, "working on dopamine"), dopamine being a common neurotransmitter. Dopaminergic substances or actions increase dopamine-related activity in the brain. Dopaminergic brain pathways facilitate d ...
D1 or D2; muscarinic
Muscarinic acetylcholine receptors, or mAChRs, are acetylcholine receptors that form G protein-coupled receptor complexes in the cell membranes of certain neurons and other cells. They play several roles, including acting as the main end-rece ...
; or opioid receptor
Opioid receptors are a group of inhibitory G protein-coupled receptors with opioids as ligands. The endogenous opioids are dynorphins, enkephalins, endorphins, endomorphins and nociceptin. The opioid receptors are ~40% identical to somatostatin r ...
s. Eletriptan could be efficiently co-administrated with nitric oxide synthase (NOS's) inhibitors for the treatment of NOS-dependent diseases (US patent US 2007/0254940).
Two theories have been proposed to explain the efficacy of 5-HT1 receptor agonists in migraine. One theory suggests that activation of 5-HT1 receptors located on intracranial blood vessels, including those on the arteriovenous anastomoses, leads to vasoconstriction, which is correlated with the relief of migraine headache. The other hypothesis suggests that activation of 5-HT1 receptors on sensory nerve endings in the trigeminal system results in the inhibition of pro-inflammatory neuropeptide release.
Side effects
Common side effects include hypertension
Hypertension (HTN or HT), also known as high blood pressure (HBP), is a long-term medical condition in which the blood pressure in the arteries is persistently elevated. High blood pressure usually does not cause symptoms. Long-term high bl ...
, tachycardia
Tachycardia, also called tachyarrhythmia, is a heart rate that exceeds the normal resting rate. In general, a resting heart rate over 100 beats per minute is accepted as tachycardia in adults. Heart rates above the resting rate may be normal (su ...
, headache, dizziness, drowsiness and symptoms similar to angina pectoris
Angina, also known as angina pectoris, is chest pain or pressure, usually caused by insufficient blood flow to the heart muscle (myocardium). It is most commonly a symptom of coronary artery disease.
Angina is typically the result of obstru ...
. Severe allergic reactions are rare.
Contraindications
Eletriptan is contraindicated in patients with various diseases of the heart and circulatory system, such as angina pectoris, severe hypertension, and heart failure
Heart failure (HF), also known as congestive heart failure (CHF), is a syndrome, a group of signs and symptoms caused by an impairment of the heart's blood pumping function. Symptoms typically include shortness of breath, excessive fatigue, a ...
, as well as in patients that have had a stroke or heart attack. This is due to the unusual side effect of coronary vasoconstriction due to serotonin 5HT1B antagonism, which can precipitate a heart attack
A myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow decreases or stops to the coronary artery of the heart, causing damage to the heart muscle. The most common symptom is chest pain or discomfort which may tr ...
in those already at risk. It is also contraindicated in severe renal
The kidneys are two reddish-brown bean-shaped organs found in vertebrates. They are located on the left and right in the retroperitoneal space, and in adult humans are about in length. They receive blood from the paired renal arteries; blood ...
or hepatic
The liver is a major organ only found in vertebrates which performs many essential biological functions such as detoxification of the organism, and the synthesis of proteins and biochemicals necessary for digestion and growth. In humans, it i ...
impairment due to its extensive liver metabolism through CYP3A4
Cytochrome P450 3A4 (abbreviated CYP3A4) () is an important enzyme in the body, mainly found in the liver and in the intestine. It oxidizes small foreign organic molecules (xenobiotics), such as toxins or drugs, so that they can be removed from t ...
.
Interactions
Strong inhibitors of the liver enzyme CYP3A4, such as erythromycin
Erythromycin is an antibiotic used for the treatment of a number of bacterial infections. This includes respiratory tract infections, skin infections, chlamydia infections, pelvic inflammatory disease, and syphilis. It may also be used duri ...
and ketoconazole
Ketoconazole, sold under the brand name Nizoral among others, is an antiandrogen and antifungal medication used to treat a number of fungal infections. Applied to the skin it is used for fungal skin infections such as tinea, cutaneous candid ...
, significantly increase blood plasma concentration of eletriptan and should be separated by at least 72 hours. Ergot alkaloid
Ergoline is a chemical compound whose structural skeleton is contained in a variety of alkaloids, referred to as ergoline derivatives or ergoline alkaloids. Ergoline alkaloids, one being ergine, were initially characterized in ergot. Some of thes ...
s, such as dihydroergotamine, add to the drug's hypertensive effect and should be separated by at least 24 hours.
Additional chemical names
* Merck Index
''The Merck Index'' is an encyclopedia of chemical substance, chemicals, pharmaceutical drug, drugs and biomolecule, biologicals with over 10,000 monographs, monograph on single substances or groups of related chemical compound, compounds publis ...
: 3- (2''R'')-1-Methyl-2-pyrrolidinylethyl]-5- -(phenylsulfonyl)ethyl1H-indole
* 5- -(benzenesulfonyl)ethyl3-(1-methylpyrrolidin-2(''R'')-ylmethyl)-1H-indole
* (''R'')-5- -(phenylsulfonyl)ethyl3- 1-methyl-2-pyrrolidinyl)methyl1H-indole
Society and culture
Brand names
It is sold in the United States, Canada, Australia, and the United Kingdom under the brand name Relpax,
References
External links
*
*
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