Almogran (almotriptan)

How do I take it?

• Almogran tablets can be taken with or without food. The tablets should be swallowed with a drink of water.
• One Almogran tablet should be taken as early as possible after the migraine headache has started, though it is also effective if taken at a later stage during the migraine attack.
• If the first dose of this medicine doesn't relieve your migraine headache then you should NOT take another dose for the same attack, as this has not been studied in clinical trials.
• If your first dose does initially relieve your migraine, but the headache then comes back, you can take a second dose. However, if you need a second dose because your migraine has returned, you should NOT take it within two hours of your first dose.
• Do not take more than two tablets in any 24 hour period.

Use with caution in

• People who are allergic to medicines from the sulphonamide group, eg the antibiotic sulfamethoxazole.
• High blood pressure (hypertension).
• People with risk factors for ischaemic heart disease, such as smoking, high cholesterol levels, diabetes, obesity, or a family history of heart disease.
• Men over 40 years.
• Postmenopausal women.
• Decreased kidney function. People with severe kidney failure should not take more than one tablet in any 24 hours. Ask your doctor for advice if you have kidney problems.
• Decreased liver function.
• History of seizures eg epilepsy, or people with conditions that increase the risk of seizures, eg head injury, alcoholism.

Not to be used in

• People who have had a heart attack.
• Heart disease caused by inadequate blood flow to the heart (ischaemic heart disease), eg angina.
• A severe form of angina pectoris, not caused by exertion (Prinzmetal's angina).
• Narrowing of blood vessels in the extremities, eg legs (peripheral vascular disease).
• History of stroke.
• History of small temporary temporary strokes (transient ischaemic attacks).
• Uncontrolled or severe high blood pressure (hypertension).
• Severely decreased liver function.
• People who have taken a monoamine-oxidase inhibitor antidepressant (MAOI) in the last 14 days.
• A form of migraine associated with paralysis of the eye muscles (ophthalmoplegic migraine).
• A form of migraine associated with temporary paralysis of one side of the body (hemiplegic migraine).
• A type of migraine where there is a disturbance in brain function which initially presents with total blindness followed by dizziness, speach disturbances, ringing in the ears and double vision (basilar migraine).
• Almogran tablets are not recommended for children or adolescents aged under 18 years, or adults aged over 65 years, as the safety and efficacy of the tablets have not been established in these age groups.
• This medicine should not be used if you are allergic to any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.

If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

The safety of this medicine for use during pregnancy has not been established. It is not recommended for use in pregnancy unless considered essential by your doctor. Seek medical advice from your doctor.
This medicine may pass into breast milk and it should be used with caution by breastfeeding mothers. Exposure of the baby to the medicine can be minimised by not breastfeeding for 24 hours following a dose. Seek medical advice from your doctor.
Side effects

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

Common 

• Dizziness.
• Fatigue.
• Sleepiness.
• Nausea and vomiting (though these may also be due to the migraine).

Uncommon 

• Pins and needles (paraesthesia).
• Headache.
• Sensation of ringing, or other noise in the ears (tinnitus).
• Awareness of your heartbeat (palpitations).
• Feeling of tightness in the throat.
• Diarrhoea.
• Indigestion.
• Dry mouth.
• Pain in the muscles (myalgia).
• Weakness or loss of strength (asthenia).
• Chest pain.

Very rare 

• Faster than normal heart beat ( tachycardia).
• Heart attack.

The side effects listed above may not include all of the side effects reported by the medicine's manufacturer.

For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

How can this medicine affect other medicines?

It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while taking this one, to make sure that the combination is safe.

This medicine must not be taken in combination with any other triptan medicines, eg zolmitriptan, eletriptan, naratriptan, sumatriptan.

This medicine must not taken within 24 hours of taking ergotamine or its derivatives, eg dihydroergotamine or methysergide. These medicines should not be taken within six hours of taking almotriptan.

If your first dose of almotriptan does not work to relieve your migraine, it is fine to take a painkiller containing aspirin, paracetamol, or a non-steroidal anti-inflammatory drug (NSAID), such as ibuprofen. However, as noted above, you should not take ergotamine, dihydroergotamine or methysergide for at least six hours after taking almotriptan.

There may be an increased risk of a rare side effect called the serotonin syndrome if almotriptan is taken in combination with other medicines that enhance the activity of serotonin in the central nervous system, such as the following:

• monoamine oxidase inhibitor (MAOIs), for example, the antidepressants phenelzine, tranylcypromine, isocarboxazid and moclobemide and the antibiotic linezolid (you should not take almotriptan if you have taken one of these medicines in the last 14 days)
• selective serotonin reuptake inhibitor antidepressants (SSRIs), such as citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine or sertraline
• serotonin noradrenaline reuptake inhibitors (SNRIs), such as venlafaxine or duloxetine
• the herbal remedy St John's wort (Hypericum perforatum).

If you are taking any of these medicines you should let your doctor know if you experience symptoms such as confusion, agitation, tremor, muscle twitching, shivering, sweating, racing heartbeat or diarrhoea after taking almotriptan.

References:

https://www.hpra.ie/img/uploaded/swedocuments/PIL%202146993-2146993-05062014144202-635375761235086250.pdf

https://www.medicines.org.uk/emc/product/6579/pil

http://www.netdoctor.co.uk/medicines/aches-and-pains/a8241/almogran-almotriptan/

http://www.medicines.ie/31238_almogran-12-5-mg-film-coated-tablet

https://patient.info/medicine/almotriptan-for-migraine-almogran