Section 02 · Monograph

Almotriptan

Reviewed Nov 2026FDA label

AxertTriptan

Indications

Selective agonist at 5-HT1B and 5-HT1D receptors, producing cranial vessel vasoconstriction and inhibition of pro-inflammatory neuropeptide release from trigeminal sensory nerves, thereby reducing trigeminovascular pain transmission

Adults and adolescents: single oral dose of 6.25 mg or 12.5 mg; 12.5 mg tends to be more effective in adults
May repeat once after 2 hours if migraine returns; maximum 25 mg per 24 hours
Safety not established for treating more than 4 migraine attacks per month

Hepatic or severe renal impairment, or concomitant potent CYP3A4 inhibitors (e.g., ketoconazole): start at 6.25 mg, max 12.5 mg/24 hours

Ischemic heart disease (angina pectoris, history of MI, or documented silent ischemia) or coronary artery vasospasm (including Prinzmetal's angina)
History of stroke or transient ischemic attack, or history of hemiplegic or basilar migraine
Peripheral vascular disease
Ischemic bowel disease
Uncontrolled hypertension
Recent (within 24 hours) use of another 5-HT1 agonist (triptan) or an ergotamine-type medication
Use of an MAOI within the preceding 2 weeks
Severe hepatic impairment
Known hypersensitivity to almotriptan

Contraindicated within 24 hours of another triptan or an ergot-type agent (additive vasospastic risk)
Contraindicated with MAOIs (used within past 2 weeks) — increased serotonin syndrome / toxicity risk
Concomitant SSRIs/SNRIs: risk of serotonin syndrome — monitor closely
Potent CYP3A4 inhibitors (ketoconazole and similar) increase almotriptan exposure (~60% with ketoconazole) — reduce starting dose and max daily dose
Partial hepatic (CYP3A4, MAO) and renal elimination — use caution in impairment even without CYP3A4 inhibitor co-administration

Adults: nausea, dry mouth, and paresthesia are the most common events
Adolescents: dizziness, somnolence, headache, paresthesia, nausea, and vomiting
Serious but rare: myocardial ischemia/infarction, coronary artery vasospasm, ventricular arrhythmias, cerebrovascular events, serotonin syndrome
Generally considered to have a favorable tolerability profile relative to other triptans

Cardiovascular risk assessment before first dose in patients with risk factors for CAD; consider ECG and in-office first dose with cardiovascular monitoring
Renal and hepatic function when impairment is present, to guide dose
Monitor for signs/symptoms of serotonin syndrome with concomitant serotonergic drugs

Limited human pregnancy data; animal studies showed developmental toxicity at exposures exceeding clinical use — use only if potential benefit justifies potential fetal risk
Unknown whether almotriptan is excreted in human milk; animal studies show milk levels approximately 7-fold plasma levels — caution advised with breastfeeding