Treximet

Triptan (5-HT1B/1D agonist), NSAID (naproxen), Antimigraine agent, Fixed-dose combination

Sumatriptan / Naproxen

Treximet

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Summary

Classes

Triptan (5-HT1B/1D agonist), NSAID (naproxen), Antimigraine agent, Fixed-dose combination

Common uses

Acute migraine treatment (with or without aura)▲0▼

Pharmacy

Starting dose

1 tablet (85/500 mg sumatriptan/naproxen) PO at migraine onset; may repeat after 2 hours if needed; maximum 2 tablets per 24 hours

Preparations

85 mg sumatriptan / 500 mg naproxen sodium tablets; lower-dose 10/60 mg pediatric (Treximet pediatric)

US FDA Max

2 tablets per 24 hours; ≤4 days per month to avoid medication-overuse headache

Pharmacology

Routes

Oral

Onset

Headache relief at 30-60 minutes

Duration

4-8 hours

Half-life

Sumatriptan ~2.5 hours; naproxen 12-15 hours

Bioavailability

Sumatriptan ~15% (oral; substantial first-pass); naproxen ~95%

Pregnancy

Avoid; NSAID-class restriction after 20 weeks (FDA 2020) and limited triptan pregnancy data.^{[citation needed]}

Legal status

Rx-only in US. NSAID-class Boxed Warning for CV thrombotic events and GI bleeding; triptans contraindicated in coronary artery disease, peripheral vascular disease, uncontrolled hypertension, and recent ergot or MAOI use

Purported mechanism

Sumatriptan is a selective 5-HT1B and 5-HT1D receptor agonist that vasoconstricts intracranial arteries and inhibits trigeminal nerve transmission, reversing the neurovascular mechanism of migraine. Naproxen is a non-selective NSAID providing anti-inflammatory adjuvant effect; the combination outperforms either agent alone in randomized trials (faster onset, longer-lasting relief, lower 24-hour recurrence).▲0▼ The dual-mechanism design exploits the inflammatory component of migraine that triptan monotherapy does not fully address. Risk of serotonin syndrome with SSRIs/SNRIs is theoretical but generally not seen clinically at triptan doses.