Eletriptan

Evidence Level: L5

Predicted Indications: 3

Eletriptan

Pharmacist Assessment Report

Eletriptan: Atrophoderma vermiculata

One-Sentence Summary

Eletriptan is a triptan (5-HT1B/1D receptor agonist) originally used for the acute treatment of migraine. The TxGNN model predicts it may be effective for atrophoderma vermiculata, but there are currently no registered clinical trials and only indirect support from 17 publications, mostly general migraine reviews and trials, with one study showing no benefit when eletriptan was given during the aura phase.

Quick Overview

Item	Content
Original Indication	Not recorded in the local data
Predicted New Indication	Atrophoderma vermiculata
TxGNN Prediction Score	0.9994
Evidence Level	L5
Canada Market Status	Marketed (marketed DINs: 14 of 14)
Number of DINs	14 (marketed: 14)
Recommended Decision	Hold

Why is This Prediction Reasonable?

Detailed mechanism of action data is not available in the data compiled for this report. Based on the published literature, eletriptan is a selective 5-HT1B/1D receptor agonist. Its affinity for the 5-HT1D receptor is about 6-fold greater than sumatriptan’s, and for the 5-HT1B receptor about 3-fold greater. This class acts on the trigeminovascular pathway that drives migraine headache.

There are two cautions:

One randomised trial (PMID 15469451) found no effect when eletriptan 80 mg was taken during the aura phase of migraine.
Triptans have historically been used cautiously in brainstem aura (formerly basilar-type migraine) because of theoretical vasoconstriction concerns.

Clinical Trial Evidence

Currently no related clinical trials registered.

Literature Evidence

None of the publications below studies migraine with brainstem aura directly. They cover eletriptan or triptans in migraine generally.

PMID	Year	Type	Journal	Key Findings
15469451	2004	RCT	Eur J Neurol	Eletriptan 80 mg taken during the aura phase had no effect on headache
11844898	2002	RCT	Eur Neurol	Eletriptan 40 mg and 80 mg compared with ergotamine plus caffeine and placebo in acute migraine (double-blind, placebo-controlled)
25600718	2015	Review	Headache	American Headache Society evidence assessment of acute migraine pharmacotherapies
11687056	2001	Review	Cochrane Database Syst Rev	Review of eletriptan for acute migraine (later withdrawn, see PMID 17636718)
12498013	2002	Review	Curr Opin Investig Drugs	Eletriptan as a 5-HT1B/1D agonist for migraine with and without aura
21028917	2010	Review	Paediatr Drugs	Use of triptans for paediatric migraine
12807526	2003	Clinical study	Cephalalgia	Eletriptan in 446 patients who had responded poorly to or not tolerated oral sumatriptan
25155004	2014	Case report	Rev Port Cardiol	Non-ST-elevation myocardial infarction a few hours after taking eletriptan, with a suggested causal association
11050304	2000	Pharmacology	Eur J Pharmacol	Contractile effects of eletriptan and sumatriptan on human isolated meningeal and coronary arteries
17501848	2007	Clinical study	Headache	Eletriptan improved functional and work productivity outcomes during migraine attacks

Canada Market Information

Eletriptan has 14 valid single-ingredient authorisations in Canada and none are cancelled. Dosage form and approved-indication text are not available in the data compiled for this report. The main authorisations are:

DIN	Product Name
02256290	RELPAX
02256304	RELPAX
02342235	MYLAN-ELETRIPTAN
02382091	TEVA-ELETRIPTAN
02479451	AURO-ELETRIPTAN

Safety Considerations

Contraindication-related conditions (from the drug-disease knowledge graph, not from label text):

Cardiovascular and cerebrovascular: hypertension, coronary artery disease, myocardial infarction, myocardial ischemia, Prinzmetal angina, stroke, transient ischemic attack, brain ischemia, peripheral vascular disease, Raynaud disease, ischemic bowel disease, vertebrobasilar insufficiency
Migraine subtype: familial or sporadic hemiplegic migraine
Other: liver disease and liver failure, serotonin syndrome, diabetes, obesity

Vertebrobasilar insufficiency, hemiplegic migraine and cerebrovascular conditions are particularly relevant to brainstem aura, because they overlap with the vasoconstriction concern for this subtype.

Drug interactions: 94 interactions were identified. Major-level interactions include:

Clarithromycin
Serotonergic or anorectic agents: lorcaserin, fenfluramine, dexfenfluramine, sibutramine
5-HT3 antagonists: ondansetron, granisetron, dolasetron, palonosetron

Moderate-level interactions include aprepitant, morphine, cimetidine, clotrimazole and miconazole.

Case report: One published case describes a myocardial infarction after eletriptan use (PMID 25155004).

Conclusion and Next Steps

Decision: Hold

Rationale:

The prediction is mechanistically plausible but supported only by indirect, general migraine evidence (L4), and no trials exist for this subtype. A randomised trial found no benefit when eletriptan was taken during the aura phase. Triptans are traditionally used cautiously in brainstem aura because of vasoconstriction concerns, and the knowledge graph lists several cerebrovascular conditions as contraindications.

To proceed, the following is needed:

Health Canada package insert warnings and contraindications (a blocking gap for safety screening)
Mechanism of action data (for example from DrugBank)
Evidence specific to migraine with brainstem aura, such as case series or registry data on triptan use and cerebrovascular safety in this subtype
A cardiovascular and cerebrovascular risk assessment and a patient-selection plan before any prospective study

Other predictions (all Hold, evidence level L5): The other three predictions have no supporting trials or literature and no plausible mechanistic link beyond a speculative one for sciatic neuropathy. They are atrophoderma vermiculata (0.9994), ulerythema ophryogenesis (0.9989) and sciatic neuropathy (0.9903).

Disclaimer

This content is for research purposes only and does not constitute medical advice. Clinical validation is required before any clinical application.