THE SAFETY OF TRIPTANS DURING PREGNANCY OR BREASTFEEDING
THIS MEDICATION MAY CAUSE HARM TO YOUR BABY:Triptans should not be taken during pregnancy unless the benefits of treatment outweigh the potential risks to the baby. There is limited safety information available on the use of triptans during pregnancy, but human studies suggest low potential risk. Caution is advised when continuing this medication during pregnancy or while nursing a baby.
What are triptans?
Triptan medications are used to treat migraine headache. Migraines can be caused by many different factors including genetics, hormones, food, and medical conditions. Types of triptans that are available include almotriptan, eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Imitrex), zolmitriptan (Zomig). Of the available triptans, none can be purchased without a prescription.
What are triptans used to treat?
Triptans are used to manage symptoms of acute migraine with or without aura in children, adolescents, and/or adults. It is estimated that 60% to 70% of women with migraines will see improvements in their migraines such as decreased severity, frequency, or duration during pregnancy. Pregnancy-related improvements in migraines may be more common in women who suffer from menstrual migraine, migraine without aura, and who experience migraine relief during the first trimester of pregnancy.
What is migraine?
Migraine headache is a neurovascular disorder that causes nerves to become inflamed and dilated. Migraine is characterized by episodes of pain lasting more than 2 hours, desire to be still or silent, and changing location of pain between episodes. Migraines cause moderate to severe pain and can be accompanied by sensitivity to light and noise. Aura or temporary vision loss can occur with some migraines and often occurs 10-30 minutes before the migraine headache. Compared to chronic migraine, episodic migraine is characterized by fewer migraine days per month as well as decreased duration and severity of migraines.
How do triptans work?
Triptans work by binding to serotonin receptors in the brain, causing vasoconstriction or the narrowing of blood vessels to occur as well as decreased inflammation. Frovatriptan and naratriptan take longer to eliminate from the body than other triptans, so other triptans may be preferred if required during pregnancy. Triptans are most effective when taken at the onset of migraine headache. Another dose can be readministered in 2 hours after the initial dose if the migraine remains (maximum daily doses are recommended, especially during pregnancy).
If I am taking a triptan, can it harm my baby?
There is limited information on the safety of triptan use during pregnancy. It may be recommended to use other medications to treat initial migraine in pregnancy. It is important to consider the risks and benefits of this medication before taking it during pregnancy.
A large analysis of six studies found no increased risk of birth defects or premature delivery with prenatal triptan use; however, prenatal triptan exposure was associated with an increased risk of miscarriage and untreated migraines were associated with an increased risk of birth defects. The Norwegian Mother and Child Cohort Study evaluated triptan use in 69,000 women exposed to triptans during pregnancy. First trimester exposure to triptans was not associated with an increased risk of birth defects. A German study in 432 women found no increase in risk of preterm birth, preeclampsia, or spontaneous abortion with triptan exposure during pregnancy. Studies evaluating the effects of in utero triptan exposure on neurobehavioral development have found no negative effects on communication or behavior in 3 year old children. Much of the evidence that is available on the safety of triptans during pregnancy is around sumatriptan. A 2008 review on triptans concluded that sumatriptan was safe for first trimester treatment of migraine headaches, but there was not enough evidence to conclude that similar triptans were also safe during pregnancy. A study from the Danish Birth Registry also evaluated the safety of sumatriptan during pregnancy, finding an increased risk of preterm birth and low birth weight likely due to the migraine itself, not sumatriptan. The manufacturer registry study on sumatriptan found no increased risk of birth defects or miscarriage in women exposed to sumatriptan during all stages of pregnancy (including the first trimester).
Bottom line: There is limited safety information available on the use of triptans during pregnancy. Human studies that have looked at the safety of triptans during pregnancy note there is no increased risk of birth defects with use during pregnancy. It is important to weigh the risks versus benefits of taking this medication during pregnancy.
If I am taking a triptan drug and become pregnant, what should I do?
If you are taking a triptan and become pregnant, you should contact your doctor immediately. Your doctor will determine if your medication is medically necessary, or if it should be discontinued until after the birth of your baby.
If I am taking a triptan, can I safely breastfeed my baby?
Caution is advised when administering triptans in women who are nursing babies. The effects of triptan exposure in nursing infants are unknown. The American Academy of Pediatrics considers sumatriptan to be compatible with breastfeeding.
Bottom line: There are no human reports on the effects of triptans in women who are nursing babies. Caution is advised when nursing babies are exposed to triptans.
If I am taking a triptan, will it be more difficult to get pregnant?
Decreased fertility has been reported in animals exposed to triptans including sumatriptan and almotriptan, but not zolmitriptan.
If I am taking a triptan, what should I know?
There is limited safety information available on the use of triptans during pregnancy. Human studies suggest there is no increase in risk of birth defects with triptan exposure during pregnancy. It is important to weigh the risks versus benefits before taking this medication during pregnancy.
There is no available safety information on the effects of triptans in women who are nursing babies. Caution is advised when triptans are administered to women who are breastfeeding babies.
If I am taking any medication, what should I know?
This report provides a summary of available information about the use of triptans during pregnancy and breastfeeding. Content is from the product label unless otherwise indicated.
You may find Pregistry's expert report about migraine here, and reports about the individual medications used to treat migraine headaches here and here. Additional information can also be found in the resources below.
For more information about triptans and migraines during and after pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446]) or check the following links:
American Migraine Foundation: What causes migraine?
Office on Women’s Health: Migraine
Janssen: Axert Prescribing Information
US Food and Drug Administration: Zolmig Prescribing Information
Glaxo Smith Kline: Imitrex Prescribing Information