Frovatriptan
FROVA
Pronunciation: froe-va-TRIP-tan (FROE-va)
What it is5-HT1B/1D agonist with the longest half-life of the triptans; acute migraine.
Why this oneThe long duration suits menstrual migraine, where it is used for short-term prevention.
What limits itSlow onset, so it is wrong for a fast attack. Coronary vasospasm.
FDA-approved for
- migraine (2001)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Acute migraine | Adults | 2.5 mg PRN | 2.5 mg PRN | 7.5 mg (3 tablets)/24h |
Renal Undefined
Hepatic Undefined
Second dose ≥2 h after first; max 3 tablets/24h; no evidence a 2nd dose helps initial non-responders
Instructions
- Take with fluids
- May repeat once ≥2 h after first dose if migraine recurs
Available strengths
- tab 2.5 mg
Contraindications
- Ischemic coronary artery disease or coronary artery vasospasm (incl. Prinzmetal's angina)
- Wolff-Parkinson-White syndrome or other cardiac accessory conduction pathway disorders
- History of stroke, TIA, or hemiplegic/basilar migraine
- Peripheral vascular disease
- Ischemic bowel disease
- Uncontrolled hypertension
- Recent use (within 24 h) of another 5-HT1 agonist or ergotamine/ergot-type medication
Cautions
- Myocardial ischemia/infarction and Prinzmetal's angina
- Arrhythmias — discontinue if occur
- Chest/throat/neck/jaw pain or tightness
- Cerebral/subarachnoid hemorrhage and stroke
- GI and peripheral vasospastic reactions
- Medication overuse headache
- MAOIs due to risk of serotonin syndrome
- Blood pressure increases
Adverse reactions
- Dizziness
- Headache
- Paresthesia
- Dry mouth
- Dyspepsia
- Fatigue
- Hot/cold sensation
- Chest pain
- Flushing
Pregnancy No adequate human data; developmental toxicity in animals at higher-than-clinical doses
Lactation No human data; present in rat milk
Cost
| Strength | #/mo | generic $/unit | CostPlus | |
|---|---|---|---|---|
| 2.5 mg | tab | per unit | $2.72/ea | offered |
Generic entry2014
NO BOXED WARNINGS
Principal riskSlow onset; coronary vasospasm
Classes and tags
Clinical profile
Legacy pregnancy categoryUnknown / historical label unavailable
Defining liabilityAgent-specific vascular, serotonergic or hepatic risks; acute overdose is usually limited outside ergot or cardiovascular agents.
Serotonicity
This drug is routinely called serotonergic. By Gillman’s human-effect criteria it does not raise serotonin in the synapse.
Triptan receptor agonism is not a mechanistic serotonin-toxicity interaction with SRIs.
Gillman’s four human testsA measurable SERT affinity that fails all four is not clinical serotonicity.
- Retarded orgasm
- Efficacy in OCD and cataplexy
- Clonus and hyperreflexia in single-drug overdose
- Serotonin toxicity when combined with an MAOI
Non-elevating action5-HT1B/1D agonist
Evidence confidenceHigh
Background: what serotonicity is · what is and is not an SRI · what counts as a relevant MAOI.