Naratriptan

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Naratriptan on Prescriptsy

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Important information about this medicine

The information on this page is for general reference and does not replace advice from a healthcare professional. Naratriptan is a prescription-only medicine (POM) that should only be used for migraine attacks that have been diagnosed by a doctor.

• Naratriptan is used to treat the headache phase of a migraine attack. It is not a preventive treatment and will not reduce the number of migraines you experience.
• If you develop sudden severe chest pain, tightness in the throat, difficulty breathing, or signs of an allergic reaction after taking naratriptan, call 999 immediately.
• Always read the Patient Information Leaflet supplied with your tablets before taking this medicine.

What is naratriptan and what is it used for?

Naratriptan is a prescription-only medicine belonging to a group of drugs called triptans, also known as selective serotonin (5-HT1B/1D) receptor agonists.

It is used to treat the headache and associated symptoms of acute migraine attacks in adults, with or without aura.

Naratriptan is available as 2.5 mg film-coated tablets and is marketed under brand names including Naramig, although generic versions are widely available on NHS prescription.

Migraine is a complex neurological condition that affects approximately one in seven people in the United Kingdom.

It is characterised by recurrent episodes of moderate to severe headache, often on one side of the head, accompanied by symptoms such as nausea, vomiting and sensitivity to light and sound.

Some people experience aura before the headache begins, which may include visual disturbances such as flashing lights, zigzag lines or blind spots, as well as tingling or numbness in the face or hands.

Naratriptan works by narrowing (constricting) the blood vessels around the brain that become dilated during a migraine attack and by blocking the release of certain chemicals from nerve endings that contribute to migraine pain and inflammation.

It is effective at relieving headache, nausea and sensitivity to light and sound when taken during an acute attack.

How naratriptan compares with other triptans

There are seven triptans available in the United Kingdom: sumatriptan, naratriptan, zolmitriptan, rizatriptan, eletriptan, almotriptan and frovatriptan.

All work through the same mechanism but differ in how quickly they are absorbed, how long they last in the body, and their overall tolerability profile.

Naratriptan has a longer elimination half-life of approximately six hours, compared with roughly two hours for sumatriptan.

This means the drug remains active in the body for longer, which translates into a lower rate of headache recurrence within 24 hours.

Clinical studies have consistently shown that naratriptan has one of the lowest recurrence rates among the triptans, making it a particularly useful option for people whose migraines tend to come back after initial relief with a faster-acting triptan.

The trade-off is that naratriptan has a slightly slower onset of action.

Peak blood levels are reached in two to three hours after oral administration, compared with one to two hours for sumatriptan.

For patients who need the fastest possible relief, a rapidly absorbed triptan may be preferable.

However, for patients whose priority is sustained relief and fewer rebound headaches, naratriptan offers a genuine clinical advantage.

Naratriptan also tends to produce fewer side effects than some of the more potent triptans such as eletriptan and rizatriptan.

The characteristic triptan sensations of tightness, tingling and pressure are generally milder and less frequent with naratriptan, which makes it a good choice for patients who find side effects troublesome with other triptans.

How naratriptan works in the body

During a migraine attack, several processes occur within the brain and its surrounding blood vessels.

The trigeminal nerve, which supplies sensation to the face and head, becomes activated and releases inflammatory neuropeptides including calcitonin gene-related peptide (CGRP) and substance P.

These chemicals cause blood vessels in the meninges (the membranes surrounding the brain) to dilate and become inflamed, which generates the characteristic throbbing pain of migraine.

Naratriptan binds selectively to two subtypes of serotonin receptor: 5-HT1B receptors on cranial blood vessels, causing them to constrict back to their normal diameter, and 5-HT1D receptors on trigeminal nerve endings, inhibiting the release of pro-inflammatory neuropeptides.

Together, these actions interrupt the migraine process at two key points, providing relief from both the headache and its associated symptoms.

Because naratriptan is highly selective for cranial blood vessels and has minimal effect on blood vessels elsewhere in the body, it does not significantly raise blood pressure in most patients.

However, as with all triptans, it should not be used in people with established cardiovascular disease or uncontrolled hypertension.

Who can take naratriptan?

Adults aged 18 to 65 with diagnosed migraine

Naratriptan is licensed for adults between the ages of 18 and 65 who have been diagnosed with migraine by a doctor.

It is suitable for treating individual migraine attacks, whether they occur with or without aura.

It can be used by people who have tried over-the-counter painkillers such as paracetamol, ibuprofen or aspirin and found them insufficient, as well as people who have used other triptans and are looking for an alternative with a different tolerability profile.

People who should not take naratriptan

Naratriptan must not be used by people with a history of heart attack, stroke, transient ischaemic attack, angina (including Prinzmetal or variant angina), or peripheral vascular disease.

It is contraindicated in people with uncontrolled high blood pressure, severe kidney impairment (creatinine clearance below 15 ml per minute), or severe liver impairment (Child-Pugh grade C).

It must not be taken at the same time as ergotamine-containing medicines or other triptans.

People who need extra caution

Your doctor may wish to carry out a cardiovascular assessment before prescribing naratriptan if you have risk factors for heart disease.

These include smoking, high cholesterol, diabetes, obesity, a strong family history of coronary artery disease, or being a man over 40 or a postmenopausal woman.

If naratriptan is considered appropriate despite these risk factors, your doctor may recommend that the first dose be taken in a supervised clinical setting.

How to take naratriptan

Take one 2.5 mg tablet as soon as you recognise that the headache phase of your migraine has started. Swallow it whole with a glass of water.

You may take naratriptan with or without food, although absorption may be slightly delayed after a heavy meal.

Naratriptan works best when taken early in the headache phase, while the pain is still mild to moderate.

It is not effective when taken during the aura phase before headache onset. If you take it during the aura, it will not prevent the headache from developing.

If your migraine improves but then returns within 24 hours, you may take a second 2.5 mg tablet, provided at least four hours have passed since the first dose. The maximum dose is two tablets (5 mg) in 24 hours.

If the first tablet has no effect whatsoever on your migraine, do not take a second tablet for the same attack, as it is unlikely to provide additional benefit.

You may, however, treat a different migraine attack with naratriptan as normal.

What to expect when taking naratriptan

Naratriptan typically begins to relieve headache within one to two hours of taking the tablet.

Because of its slower onset compared with some other triptans, you may notice a more gradual improvement rather than rapid relief.

By four hours after the dose, clinical trials show that approximately 60 to 68 per cent of patients experience meaningful headache relief, and around 40 to 45 per cent are completely pain-free.

One of the key advantages of naratriptan is its sustained effect.

Because the drug remains active in the body for longer, the headache is less likely to return once it has resolved.

In clinical studies, headache recurrence within 24 hours occurred in approximately 17 to 28 per cent of patients treated with naratriptan, compared with 30 to 40 per cent for sumatriptan.

If sustained relief is a priority for you, this is an important consideration when discussing treatment options with your GP.

Naratriptan relieves not only headache but also associated migraine symptoms including nausea, vomiting, photophobia (sensitivity to light) and phonophobia (sensitivity to sound). Many patients report being able to return to normal activities within a few hours of taking the tablet.

Naratriptan for menstrual migraine

Menstrual migraine, also known as menstrually related migraine, is a pattern of migraine attacks that occurs consistently around the time of menstruation, typically in the two days before and the first three days of the period.

It is driven by the natural fall in oestrogen levels that triggers menstruation.

Menstrual migraines tend to be longer, more severe and more resistant to treatment than migraines at other times of the cycle.

Naratriptan has been studied as a short-term preventive treatment (also called mini-prophylaxis) for menstrual migraine.

In this approach, naratriptan 1 mg or 2.5 mg is taken twice daily for several days around the expected onset of menstruation.

Clinical trials have shown that this strategy can reduce the frequency and severity of menstrual migraine attacks.

This use is off-label in the UK but may be recommended by your GP or headache specialist if other approaches have not worked.

NICE Clinical Knowledge Summaries acknowledge this approach as an option for women with predictable menstrual migraine.

Side effects of naratriptan

Like all medicines, naratriptan can cause side effects, although not everybody gets them. Naratriptan is generally well tolerated and tends to cause fewer and milder side effects than some other triptans.

Common side effects

These may affect up to 1 in 10 people and include sensations of tingling, warmth, heaviness, pressure or tightness, which can affect any part of the body including the chest and throat.

These sensations are characteristic of all triptans and usually pass within 30 minutes.

Other common effects include feeling generally unwell or fatigued, flushing or a feeling of warmth, nausea, and dizziness or drowsiness.

Uncommon and rare side effects

Uncommon side effects (up to 1 in 100 people) include visual disturbances, palpitations and skin rash.

Rare effects (up to 1 in 1,000 people) include hypersensitivity reactions such as urticaria and, very rarely, anaphylaxis. Bradycardia has been reported in rare cases.

Very rare cardiovascular events including coronary artery vasospasm, myocardial infarction and ischaemic colitis have occurred, predominantly in patients with pre-existing risk factors.

When to seek emergency help

Call 999 or go to A&E immediately if you experience crushing chest pain, sudden weakness or numbness on one side of the body, difficulty speaking, severe shortness of breath, swelling of the face, lips or throat, difficulty breathing, severe abdominal pain with bloody diarrhoea, or signs of a severe allergic reaction.

Drug interactions

Several medicines can interact with naratriptan and must be discussed with your prescriber before starting treatment.

• Ergotamine and ergotamine-containing medicines (such as dihydroergotamine and methysergide) must not be used within 24 hours of naratriptan, as combining them may cause prolonged vasospasm.
• Other triptans must not be taken on the same day as naratriptan.
• SSRIs (such as sertraline, fluoxetine, citalopram, escitalopram, paroxetine) and SNRIs (such as venlafaxine, duloxetine) may rarely cause serotonin syndrome when combined with triptans. Your doctor should monitor you for symptoms including agitation, confusion, tremor, rapid heartbeat and high body temperature.
• St John's Wort (a herbal remedy for low mood) may also increase the risk of serotonin syndrome.
• Oral contraceptives and hormone replacement therapy may slightly reduce the clearance of naratriptan but dose adjustment is not usually required.

Always tell your doctor, pharmacist or prescriber about all medicines you are taking, including over-the-counter remedies and herbal supplements.

Lifestyle measures for migraine management

While naratriptan is effective at treating acute attacks, migraine management is most successful when medication is combined with lifestyle strategies to reduce the frequency and severity of episodes.

The following approaches are recommended by the NHS and NICE for people living with migraine.

• Keep a migraine diary to identify your personal triggers. Common triggers include stress, irregular sleep, skipping meals, dehydration, alcohol (particularly red wine), caffeine withdrawal, hormonal changes, bright or flickering lights, strong smells, and certain foods.
• Maintain regular sleeping patterns, going to bed and waking at the same time each day, including weekends.
• Eat regular meals and stay well hydrated. Low blood sugar and dehydration are common migraine triggers.
• Take regular moderate exercise, which has been shown to reduce migraine frequency in several clinical studies.
• Manage stress through techniques such as mindfulness, relaxation exercises, yoga or cognitive behavioural therapy.
• During an attack, rest in a quiet, dark room if possible. Applying a cold compress to the forehead may also help.

When to consider preventive treatment

Naratriptan is an acute treatment, meaning it is taken to stop individual migraine attacks.

If you are experiencing migraines on four or more days per month, or if your attacks are particularly prolonged, severe or disabling despite acute treatment, your GP may discuss preventive (prophylactic) medication.

NICE recommends considering preventive treatment when migraine significantly impairs quality of life despite optimal acute therapy.

Preventive options available on the NHS include propranolol, topiramate, amitriptyline and candesartan as first-line choices.

For patients who do not respond to or cannot tolerate oral preventives, newer treatments such as CGRP monoclonal antibodies (erenumab, fremanezumab, galcanezumab) may be available through specialist headache services in accordance with NICE technology appraisals.

Using any acute migraine treatment, including naratriptan, on 10 or more days per month risks developing medication-overuse headache, a condition in which the frequent use of painkillers or triptans paradoxically increases headache frequency.

If you find yourself reaching for acute treatment this often, it is important to discuss this with your GP, who can help you develop a management plan that may include preventive medication and a supervised reduction in acute treatment use.

Naratriptan and the NHS

Naratriptan is available on NHS prescription throughout the United Kingdom. Generic naratriptan tablets are widely stocked by community pharmacies and are among the more affordable triptans.

In England, a standard NHS prescription charge of 9.90 pounds applies unless you are exempt. Prescriptions are free of charge in Scotland, Wales and Northern Ireland.

NICE Clinical Knowledge Summaries recommend triptans as a treatment option for acute migraine when simple analgesics are inadequate.

The choice of triptan is usually made based on individual patient factors including speed of onset required, tolerability, route of administration preferred, and pattern of headache recurrence.

Your GP will work with you to find the triptan that best suits your needs, and it is common to try more than one before identifying the most effective option for your particular migraine pattern.

If over-the-counter sumatriptan (available as a pharmacy medicine in 50 mg tablets) has been partially effective but you experience frequent headache recurrence, naratriptan may be a logical next step.

Conversely, if speed of onset is your priority, your GP may recommend a faster-acting triptan such as eletriptan or rizatriptan.

Storage and handling

Store naratriptan tablets below 30 degrees Celsius in the original packaging to protect from light and moisture. Keep the medicine out of the sight and reach of children.

Do not use naratriptan after the expiry date printed on the blister and carton. Medicines should not be disposed of via wastewater or household waste.

Return unused tablets to your pharmacy for safe disposal.

When to contact your GP or seek medical advice

Speak with your GP if naratriptan does not adequately control your migraine attacks, if your migraines are becoming more frequent or more severe, if you find yourself using triptans on 10 or more days per month, if you experience new or unusual headache patterns, or if you are considering pregnancy while using naratriptan.

For non-emergency medical advice, contact NHS 111 by phone or online. In an emergency, call 999 or attend your nearest A&E department.

Sources and further reading

• Summary of Product Characteristics, Naratriptan 2.5 mg film-coated tablets, EMC (medicines.org.uk)
• British National Formulary, Naratriptan, bnf.nice.org.uk
• NHS, Migraine, nhs.uk
• NICE Clinical Knowledge Summaries, Migraine, cks.nice.org.uk
• NICE Technology Appraisals, Triptans for acute migraine
• The Migraine Trust, Treatment and prevention, migrainetrust.org
• BASH Guidelines, British Association for the Study of Headache, bash.org.uk
• MHRA Yellow Card Scheme, Report side effects, yellowcard.mhra.gov.uk