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MagazineJune 2000 (Vol. 11 Issue 3)Eletriptan

Eletriptan is one of the newer breed of triptans for treating migraine, following in the wake of the more famous sumatriptan

Eletriptan is one of the newer breed of triptans for treating migraine, following in the wake of the more famous sumatriptan. It's cheaper, and is more effective than oral sumatriptan and a recent major trial reports that it also comes with similar adverse reactions.

The triptan family tries to control migraine attacks by changing serotonin (5-HT) levels, which also affect depression and psychosis.

However, their effectiveness can be hit or miss as they are poorly absorbed by the gut. As a result, only around two thirds of patients are ever helped by the triptans. Even the later injected triptans have a relatively high failure rate, and are also much more expensive. The injected variety of sumatriptan also comes with more adverse reactions.

The triptans are no go drugs for people suffering from a heart condition as they can cause chest pains in up to 8 per cent of patients.

The later triptans, including eletriptan, naratriptan and rizatriptan, were supposed to come without the reactions associated with sumatriptan. But a recent study on eletriptan suggests it comes with all the usual side effects (Neurology 2000; 54: 156-63).

Flushing, palpitations, nasal discomfort, eye irritation, visual disturbance and agitation were all symptoms reported way above the placebo group.

In a critique of triptans by Nicholas Bateman of the Scottish Poisons Information Bureau, there seems little to choose between them (Lancet 2000; 355: 860-1). Naratriptan seems to have fewer adverse reactions, but acts more slowly.

A better agent for treating migraine is still needed, he believes. Especially as regular use of any of the triptans can produce an increase in migraine frequency and headache (Lancet 1999; 353: 378).

Which, as Hamlet might have said, is a real bummer.

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