8 Things Pharmacists Want You to Know About Triptans

You’re going about your day and suddenly you feel a throbbing pain and pulsing sensation in your head. This bothersome feeling might be a headache or a migraine coming on. It’s something that affects a lot of people, with up to 75% of all adults reporting that they’ve experienced a headache within the past year. And about 30% of these people have had a migraine.

Migraines aren’t just severe headaches. They’re a medical condition affecting the brain, and they can be pretty complicated. In fact, it’s even possible to have a migraine without a headache. Thankfully, triptans are a group of medications that are effective at treating migraines. They’re first-choice options for treating migraine pain right after it begins.

If you have a prescription for a triptan, there’s a few things you’ll want to know — like how to use them and what side effects they may cause. 

1. Triptans come in many forms

There are multiple triptans available. And they come in many different forms. Which one your healthcare provider prescribes may depend on the symptoms you’re experiencing and your personal medical history. For more detailed information on which triptans may be best for certain symptoms and situations, check out another GoodRx article on this topic.

Here’s a look at all the available triptans and their forms. All the triptans discussed below are available in generic forms except sumatriptan nasal powder (Onzetra Xsail) and zolmitriptan nasal spray (Zomig). 

2. It’s important to take your triptan at the right time

Triptans are likely most effective when they’re taken soon after your migraine starts, when the pain isn’t that strong yet. They may not work as well if you take them when the migraine pain is severe.

For most triptans, you can take a second dose if the first dose doesn’t relieve your pain. You should usually wait at least 2 hours after your first dose. But make sure to ask your healthcare provider about your specific triptan. For example, naratriptan requires at least 4 hours between doses.

3. Triptans shouldn’t be used more than 2 days per week

Using triptans for 10 or more days a month can worsen headaches. These are called triptan-overuse headaches (or rebound headaches). According to the American Headache Society, you shouldn’t use triptans for migraines for an average of more than 2 days per week. 

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4. Triptans aren’t meant for migraine prevention

Triptans aren’t preventative medications. This means they shouldn’t be used to help you avoid, or prevent, migraines. 

If you find yourself needing triptans more than 2 days per week, talk to your healthcare provider. They may evaluate whether you’d benefit from trying a daily medication to prevent migraines. Preventative medications may include:

• Beta blockers, like metoprolol (Lopressor), propranolol (Inderal LA), and atenolol (Tenormin)

• Antidepressants, like amitriptyline and venlafaxine (Effexor XR)

• Seizure medications, like divalproex sodium (Depakote) and topiramate (Topamax)

• CGRP antagonists, like fremanezumab (Ajovy) and galcanezumab (Emgality)

• Nonsteroidal anti-inflammatory medications (NSAIDs), like ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn)

The best preventative medication for you depends on your medical history and what other medications you take. As with all medications, these preventative options have side effects to be aware of. Your healthcare provider can help you weigh the risks and benefits of starting a preventative migraine medication.

5. You should only use one triptan at a time

Taking more than one type of triptan at a time isn’t usually recommended. But if one isn’t working, you may be able to try another. For example, if you’re taking sumatriptan but it’s not working, your healthcare provider may recommend trying another triptan. You should wait 24 hours before starting the new triptan. If you need pain relief in the meantime, talk to your healthcare provider about pain relief medications you can use during the transition period.

It’s important to note that taking more than one formulation of the same triptan is OK if your healthcare provider prescribes the combination. For example, some people get better migraine relief from using sumatriptan tablets and nasal spray. But they should be taken at least 1 hour apart. And don’t use more doses than your healthcare provider prescribes.

6. Triptans can cause side effects

Like all medications, triptans can cause side effects. Individual side effects tend to vary among the various triptan formulations. But these are some side effects that are common to the triptan class as a whole:

• “Triptan sensations,” which refers to symptoms like chest tightness and pain, a tingling feeling, and throat discomfort

• Dizziness

• Dry mouth

• Nausea

• Tiredness

Serious side effects are also possible with triptans. These are rare, but it’s important to know about them. They include abnormal heart rhythm, heart attack, and stroke. Talk to your healthcare provider about these serious risks. They can help you decide if triptans are right for you.

7. Triptans can have drug interactions

Triptans can have interactions with certain medications and supplements. Before starting a triptan, ask your healthcare provider or pharmacist to check for drug interactions. Give them an updated list of all your medications to help them check.

Different triptans have their own unique drug interactions. But there are a few possible drug interactions that are common to all triptans.

Ergot derivatives

These medications are prescribed for migraines and other medical conditions. Examples of ergot derivatives include dihydroergotamine (Migranal, Trudhesa) and ergotamine (Ergomar). Avoid taking an ergot derivative within 24 hours of a triptan. Combining these medications can cause too much tightening of the blood vessels (vasoconstriction). This can cause high blood pressure. Or, more seriously, it can lead to heart attack or stroke.

Medications that raise serotonin levels

If you take medications like selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs), talk to your healthcare provider before starting a triptan. These medications and many others (including triptans) can raise serotonin levels and potentially cause serotonin syndrome. This can be a dangerous condition that sometimes requires immediate medical attention. It’s rare, but it’s more likely if you take multiple medications that raise serotonin levels.

Monoamine oxidase inhibitors

Monoamine oxidase inhibitors (MAOIs) treat many medical conditions, including depression and Parkinson’s disease. MAOIs can cause triptan levels to increase in the body and make you more likely to experience side effects. They can also raise serotonin levels. You shouldn’t take an MAOI within 2 weeks of a triptan. 

8. Some people shouldn’t use triptans

You should avoid triptans if you have certain medical conditions. If you or a loved one have any of these health conditions, it’s generally recommended to avoid triptans:

• Previous heart attack 

• Prior stroke

• Coronary artery disease

• Certain types of migraines like hemiplegic migraine (migraine with weakness on one side of the body)

• Peripheral artery disease

• High blood pressure that isn’t controlled

Women who are pregnant should also avoid triptans. The exception may be sumatriptan, which can be taken for severe headaches during pregnancy. But you should weigh the risks and benefits of this with your healthcare provider.

Your individual triptan may have more warnings. For example, sumatriptan’s labeling recommends people with severe liver damage avoid taking sumatriptan. On the other hand, rizatriptan’s labeling doesn’t have this recommendation. This difference helps highlight the importance of talking with your healthcare provider about the pros and cons of your specific triptan.

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Written by:

Kevin Le, PharmD, BCPS, BCPPS

Kevin Le, PharmD, BCPS, BCPPS is a clinical pharmacy specialist in solid organ transplant at Ann & Robert H. Lurie Children’s Hospital of Chicago. He has been working as a pediatric pharmacist since 2016.

Edited by:

Amy B. Gragnolati, PharmD, BCPS

Amy Gragnolati, PharmD, BCPS, is a pharmacy editor for GoodRx. Amy currently holds her pharmacist license in Georgia and California.

Reviewed by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

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