Frovatriptan (Frova) is a 5 HT-1 receptor agonist commonly called "Triptans". It causes intracranial vasoconstriction and is indicated for the treatment of patients with acute migraine attack. Frovatriptan has a very long half-life compared to other triptans (about five times that of other triptans) and hence, it may be indicated for the short-term prophylaxis of female patients with menstrual migraine.

Frovatriptan (Frova) Uses:

• Migraines:

  • Acute treatment of migraine with or without aura in adults
  • Limitations of use: Do not use as prophylaxis. Use only in patients with confirmed diagnosis.

• Off Label Use of Frovatriptan in Adults:

  • Menstruation-associated migraines (short-term prevention)

Frovatriptan (Frova) Dose in Adults

Note: If no improvement seen consider alternate diagnosis. No safety data of treating more than four events each month.

Frovatriptan (Frova) Dose in the treatment of Migraine:

• Oral:
  • Initial: 2.5 mg; if headache persistent repeat dose in 2 hours.
  • The maximum recommended dose is 7.5 mg/day.

Use in Children:

Not indicated.

Frovatriptan (Frova) Pregnancy Category: C

• In animal reproduction studies, adverse events were reported. 
• There are no data for humans. You can use other migraine medications during pregnancy.

Use Frovatriptan while breastfeeding

• Before starting treatment, analyze the risk-benefit ratio for both mother and baby.

Dose in Kidney Disease:

No dose adjustment is needed.

Frovatriptan (Frova) Dose in Liver disease:

• Mild to moderate impairment:

  • No dosage adjustment.

• Severe impairment:

  • No data are available.

Side Effects of Frovatriptan (Frova):

• Cardiovascular:

  • Flushing
  • Hot Or Cold Flashes
  • Chest Pain
  • Palpitations

• Central Nervous System:

  • Dizziness
  • Fatigue
  • Headache
  • Paresthesia
  • Drowsiness
  • Anxiety
  • Dysesthesia
  • Hypoesthesia
  • Insomnia
  • Pain

• Dermatologic:

  • Diaphoresis

• Gastrointestinal:

  • Xerostomia
  • Nausea
  • Dyspepsia
  • Abdominal Pain
  • Diarrhea
  • Vomiting

• Neuromuscular & Skeletal:

  • Musculoskeletal Pain

• Ophthalmic:

  • Visual Disturbance

• Otic:

  • Tinnitus

• Respiratory:

  • Rhinitis
  • Sinusitis

Contraindication to Frovatriptan (Frova):

• Ischemic coronary disease (eg angina pectoris; MI, documented silentischemia)
• Coronary artery vasospasm including Prinzmetal’s angina;
• Wolff-Parkinson White syndrome, arrhythmias and other cardiac accessory conduction pathway disorders
• History of stroke, transient Ischemia Attack, or hemiplegic migraine.
• Peripheral Vascular Disease;
• Ischemic bowel disease
• Hypertension uncontrolled
• Recent use within the last 24 hours of an ergotamine-containing or ergottype 5-HT-1 agonist (eg dihydroergotamine)
• hypersensitivity to any drug or component of the formula

Canadian labeling: Additional contraindications not in US labeling

• Cardiac arrhythmias (especially Tachycardia), valvular and congenital heart diseases, atherosclerotic diseases, and valvular heart disease are all possible.
• Management of ophthalmoplegic headaches
• Hepatic impairment severe
• There is not much evidence of triptan cross-reactivity.
•  Cross-sensitivity is possible due to similarities in chemical structure or pharmacologic effects.

Warnings and precautions

• Anaphylactoid and Anaphylactic reactions:

  • Anaphylaxis, anaphylactoid and hypersensitivity reactions (including angioedema), may occur. If you are previously hypersensitive, it is contraindicated.

• Cardiac events

  • Administration of 5-HT-1 agonist has been associated with cardiac arrest, heart failure, transient ischemia and myocardial injury.
  • Stop side effects developing
  • Before continuing with treatment, patients who experience chest pain, pressure, tightness, or other symptoms that suggest angina should be examined for Prinzmetal's or CAD. 
  • If the patient experiences the same symptoms after treatment, ECG monitoring should be performed.
  • Patients with vasospastic or ischemic CAD, Wolff-Parkinson White syndrome, or arrhythmias related to other cardiac accessory conduction pathways disorders are contraindicated.

• Cerebrovascular events

  • Contraindicated if you have a history of TIA/CVA.
  • Five-HT-1 agonist administration has been linked to strokes and cerebral/subarachnoid hemorhage (some fatal).

• High blood pressure

  • Hypertension rarely with end-organ damage, or markedly elevated blood pressure.
  • Contraindicated in conjunction with uncontrolled hypertension

• Headaches

  • If you take your medication for more than 10 days per month, withdrawal headaches can occur.

• Vasospasm-related events

  • Peripheral and gastrointestinal vascular infarction and infarction and Raynaud syndrome.

• Visual effects

  • There have been cases of partial and complete (reversible or irreversible) but no clear relationship.

• Coronary artery disease

  • Patients at high risk of developing CAD should be avoided (eg, hypertension and hypercholesterolemia; smoking obesity, diabetes, strong family history, men >40 years old, hypertension, smoking, or other factors that could increase the likelihood of developing CAD).
  • Contraindicated for CAD and coronary artery vasospasm
  • Before starting treatment, a cardiac evaluation is required. If you are using long-term treatment, follow up with periodic evaluation.

• Hepatic impairment

  • There are no data available. Please be careful.

Frovatriptan: Drug Interaction

Monitoring parameters:

• Severity of headache severity
• bloodpressure
• signs/symptoms of angina. Periodic cardiac function assessment inwin patients with long duration of therapy and multiple cardiovascular risk factors.
• signs/symptoms of serotonin syndrome and hypersensitivity reactions.

How to administer Frovatriptan (Frova)?

• Take when symptoms appear. Wash down with lots of fluids

Mechanism of action of Frovatriptan (Frova):

• Selective serotonin antagonist (5-HT-1B or 5-HT-1D receptors), in the cranial arteries. 
• Reduces migraines due to migrane headaches by increasing blood flow and decreasing inflammation.

Protein binding:

• ~15%

Metabolism:

• Primarily hepatic via CYP1A2

Bioavailability:

• Male: ~20%;
• Female: ~30%

Half-life elimination:

• ~26 hours

Time to peak:

• 2-4 hours

Excretion:

• Feces (62%);
• Urine (32%)

International Brand Names of Frovatriptan:

• Frova
• APO-Frovatriptan
• TEVA-Frovatriptan
• Allegro
• Auradol
• Eumitan
• Forvey
• Fromen
• Fromena
• Fromirex
• Frovatex
• Frovex
• Menamig
• Menatriptan
• Migard
• Miguard
• Relieva
• Tigreat

Frovatriptan Brands Names in Pakistan:

No Brands Available in Pakistan.