Announcement

Collapse
No announcement yet.

Rizatriptan and pregnancy risk

Collapse
X
 
  • Filter
  • Time
  • Show
Clear All
new posts

  • Rizatriptan and pregnancy risk

    Hello,
    I have A general question concerning migrane medications, especially rizatriptan.
    I know that most preferred is sumatriptan. Quite many patients use some other migraine medications however. Especially the ones using or rizatriptan or other sublingual tablets are sometimes hesitant to change as sumatriptan might not work as well and the administration is not as easy and fast.

    How much bigger pregnancy risk does rizatriptan have compared to sumatriptan?

    Is there any other Choise among migraine medications (triptans) that would be better choise than rizatriptan?

    Br,
    Meri Haahtela

  • #2
    MeriH,

    Rizatriptan:
    In a general reproductive study in rats, birth weights and pre- and post-weaning weight gain were reduced in the offspring of females treated prior to and during mating and throughout gestation and lactation with doses of 10 and 100 mg/kg/day. Maternal drug exposures (AUC) at these doses were approximately 15 and 225 times, respectively, the exposure in humans receiving the maximum recommended daily dose (MRDD) of 30 mg. In a pre- and post-natal developmental toxicity study in rats, an increase in mortality of the offspring at birth and for the first three days after birth, a decrease in pre- and post-weaning weight gain, and decreased performance in a passive avoidance test (which indicates a decrease in learning capacity of the offspring) were observed at doses of 100 and 250 mg/kg/day. The no-effect dose for all of these effects was 5 mg/kg/day, approximately 7.5 times the exposure in humans receiving the MRDD. With doses of 100 and 250 mg/kg/day, the decreases in average weight of both the male and female offspring persisted into adulthood. All of these effects on the offspring in both reproductive toxicity studies occurred in the absence of any apparent maternal toxicity. In embryofetal development studies, no teratogenic effects were observed when pregnant rats and rabbits were administered doses of 100 and 50 mg/kg/day, respectively, during organogenesis. Fetal weights were decreased in conjunction with decreased maternal weight gain at the highest doses (maternal exposures approximately 225 and 115 times the human exposure at the MRDD in rats and rabbits, respectively). The developmental no-effect dose in these studies was 10 mg/kg/day in both rats and rabbits (maternal exposures approximately 15 times human exposure at the MRDD). Toxicokinetic studies demonstrated placental transfer of drug in both species.There are no adequate and well-controlled studies in pregnant women; therefore, rizatriptan should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.


    Sumatriptan:
    Sumatriptan does not appear to increase the risk of congenital malformations but one study found a small increased risk for premature birth and another found a slight increase in atonic uterus and hemorrhage; therefore, as with all medications during pregnancy should only be used if the benefit to the mother outweighs the risk to the fetus. Some authors recommend triptans not be given during pregnancy due to the vasoconstricting effects of this category of medications.

    Sumatriptan is an antimigraine medication used in the treatment of acute migraine headache and cluster headaches. Several small studies have revealed no increased risk for congenital malformations. In a study by Kallen et al, there was a small increased risk for premature birth. Pfaffenrath et al stated that triptans should not be given during pregnancy but recommended nonpharmacologic therapies such as sleep, relaxation, and ice packs first, followed by 1000 mg of acetaminophen, then ibuprofen or aspirin (excluding the third trimester) for acute migraine headaches. In summary, sumatriptan does not appear to increase the risk of congenital malformations but one study found a small increased risk for premature birth and another found a slight increase in atonic uterus and hemorrhage; therefore, as with all medications during pregnancy should only be used if the benefit to the mother outweighs the risk to the fetus. Some authors recommend triptans not be given during pregnancy due to the vasoconstricting effects of this category of medications.

    Sandra Lovato R.N.
    InfantRisk Center
    806-352-2519

    Comment

    Working...
    X