Why pharmacokinetic differences among oral triptans have little clinical importance: a comment

J Headache Pain. 2011 Feb;12(1):5-12. doi: 10.1007/s10194-010-0258-4. Epub 2010 Sep 29.

Abstract

Triptans, selective 5-HT1B/1D receptor agonists, are specific drugs for the acute treatment of migraine that have the same mechanism of action. Here, it is discussed why the differences among kinetic parameters of oral triptans have proved not to be very important in clinical practice. There are three main reasons: (1) the differences among the kinetic parameters of oral triptans are smaller than what appears from their average values; (2) there is a large inter-subject, gender-dependent, and intra-subject (outside/during the attack) variability of kinetic parameters related to the rate and extent of absorption, i.e., those which are considered as critical for the response; (3) no dose-concentration-response curves have been defined and it is, therefore, impossible both to compare the kinetics of triptans, and to verify the objective importance of kinetic differences; (4) the importance of kinetic differences is outweighed by non-kinetic factors of variability of response to triptans. If no oral formulations are found that can allow more predictable pharmacokinetics, the same problems will probably also arise with new classes of drugs for the acute treatment of migraine.

Publication types

  • Comparative Study
  • Review

MeSH terms

  • Administration, Oral
  • Dose-Response Relationship, Drug
  • Humans
  • Metabolic Clearance Rate / physiology
  • Migraine Disorders / drug therapy*
  • Migraine Disorders / metabolism
  • Sex Characteristics
  • Tryptamines / administration & dosage*
  • Tryptamines / blood
  • Tryptamines / pharmacokinetics*

Substances

  • Tryptamines