Current and emerging second-generation triptans in acute migraine therapy:A comparative review

Sterile neurogenic inflammation within cephalic tissue, involving vasodilat ion and plasma protein extravasation, has been proposed as a pathophysiolog ical mechanism in acute migraine. The action of 5-hydroxytryptamine (5-HT1B /1D) agonists-so-called triptans-on receptors located in meningeal arteries (5-HT1B) and trigeminovascular fiber endings (5-HT1D) has an inhibitory ef fect on this neurogenic inflammation. Recently, a series of second-generati on 5-HT1B/1D agonists (almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, and zolmitriptan) have been developed and are reviewed in this article. Their in vitro pharmacological properties, pharmacokinetics, clin ical efficacy, drug interactions, and adverse effects are evaluated and com pared to the golden standard in the treatment of acute migraine, sumatripta n. (C) 2000 the American College of Clinical Pharmacology.