Eletriptan hydrobromide is used for the acute treatment of attacks of migraine with or without aura in adults. The manufacturer states that eletriptan should not be used for the management of hemiplegic or basilar migraine or for the prophylaxis of migraine. Safety and efficacy have not been established for the management of cluster headaches.
Efficacy of eletriptan administered at the recommended dosage of 20 or 40 mg has been evaluated for the acute treatment of migraine attacks in several randomized, placebo-controlled studies in adult outpatients with moderate to severe headaches. In these studies, 47-54 or 54-65% of patients receiving eletriptan 20 or 40 mg, respectively, achieved a response (mild to no pain) 2 hours after treatment, compared with 19-40% of patients receiving placebo. The drug also relieved manifestations of migraine other than headache (including nausea, photophobia, and phonophobia) and reduced the need for supplemental migraine therapy.
Eletriptan appears to be at least as effective as oral sumatriptan in alleviating the pain associated with migraine 2 hours after treatment. In several comparative studies, response rates 2 hours after treatment were substantially higher in patients receiving eletriptan 40 mg (64-67%) than in patients receiving sumatriptan 50 mg (50%) or 100 mg (53-59%). In another study, similar response rates were reported for eletriptan 20 or 40 mg (54 or 65%, respectively) and sumatriptan 100 mg (55%). In all comparative studies to date, sumatriptan tablets were encapsulated for the purpose of blinding, while eletriptan tablets were not. The encapsulated sumatriptan formulations were reportedly bioequivalent to conventional sumatriptan tablets; however, in another study, encapsulation of sumatriptan delayed absorption of the drug during the first 2 hours after dosing compared with conventional sumatriptan tablets. Results of a pooled analysis suggest that headache response rates 2 hours after treatment may be lower with eletriptan 20 mg than with sumatriptan 100 mg.
The US Headache Consortium considers 5-HT1B/1D receptor agonists (e.g., eletriptan) an appropriate treatment choice for the acute management of moderate to severe migraine headaches in patients without contraindications to these drugs and recommends use of 5H-T1B/1D receptor agonists, dihydroergotamine, or ergotamine in patients with more severe migraine attacks as well as in patients in whom previous therapy with nonsteroidal anti-inflammatory agents (NSAIAs) or fixed-combination preparations such as acetaminophen, aspirin, and caffeine has been ineffective.