Naramig (Naratriptan)
Triptan for Acute Migraine Treatment
Quick Facts About Naramig
Key Takeaways About Naramig
- Longer-acting triptan: Naramig has a half-life of 5–8 hours, resulting in lower migraine recurrence rates within 24 hours compared to faster-acting triptans
- Take only during an attack: Naramig should be taken once migraine headache has started – it does not prevent migraine attacks
- Maximum two tablets per day: Do not exceed 5 mg (two tablets) in a 24-hour period, with at least 4 hours between doses
- Avoid with heart conditions: Do not take Naramig if you have ischaemic heart disease, uncontrolled high blood pressure, peripheral vascular disease, or history of stroke
- Not for children or elderly: Naramig is recommended only for adults aged 18 to 65 years
What Is Naramig and What Is It Used For?
Naramig (naratriptan) is a triptan medication used to treat the headache phase of migraine attacks. It belongs to the 5-HT1 receptor agonist class and works by constricting dilated blood vessels in the brain and blocking pain signal transmission, relieving migraine headache and its associated symptoms.
Naramig contains naratriptan hydrochloride, which belongs to a group of medicines called triptans, also known as selective serotonin 5-HT1B/1D receptor agonists. These medications were specifically developed for the acute treatment of migraine and represent a significant advancement over older, less targeted treatments. Naratriptan was first approved for clinical use in the late 1990s and has been widely prescribed across Europe, North America, and other regions.
Migraine is a complex neurological condition characterised by recurrent episodes of moderate to severe headache, typically affecting one side of the head and often accompanied by nausea, vomiting, and heightened sensitivity to light (photophobia) and sound (phonophobia). The underlying pathophysiology involves activation of the trigeminovascular system, release of vasoactive neuropeptides such as calcitonin gene-related peptide (CGRP), and dilation of intracranial blood vessels. Naramig addresses these mechanisms directly.
Naramig exerts its therapeutic effect through three complementary mechanisms. First, it constricts dilated intracranial blood vessels, particularly the meningeal arteries, which are believed to contribute to migraine pain. Second, it inhibits the release of vasoactive neuropeptides (including CGRP and substance P) from trigeminal nerve endings around the blood vessels. Third, it blocks pain signal transmission in the trigeminal nucleus caudalis in the brainstem, reducing the central perception of pain.
It is essential to understand that Naramig is an acute treatment only. It should be taken once a migraine attack has begun and is not intended for the prevention of future attacks. Naramig does not treat other types of headache, including tension-type headache or cluster headache. The European Headache Federation (EHF) and the American Headache Society (AHS) both recognise triptans as first-line acute treatment for moderate to severe migraine attacks.
Compared to some other triptans, naratriptan has a relatively slow onset of action but a longer duration of effect. Its half-life of 5–8 hours is among the longest in the triptan class, which translates to a lower rate of migraine recurrence within 24 hours. This makes Naramig particularly suitable for patients who experience frequent headache recurrence after initial relief with faster-acting triptans.
What Should You Know Before Taking Naramig?
Before taking Naramig, inform your doctor about all your medical conditions, particularly any cardiovascular disease, uncontrolled hypertension, or history of stroke. Naramig is contraindicated in patients with ischaemic heart disease, peripheral vascular disease, and severe kidney or liver impairment.
Contraindications
You should not take Naramig if any of the following apply to you:
- Allergy to naratriptan or any of the other ingredients in Naramig (listed in the contents section below)
- Ischaemic heart disease (narrowed blood vessels to the heart), including coronary artery disease, angina pectoris (chest pain), or a previous heart attack (myocardial infarction)
- Peripheral vascular disease – poor circulation in the legs causing cramping pain when walking (intermittent claudication)
- History of stroke (cerebrovascular accident) or transient ischaemic attack (TIA) – a temporary disruption of blood flow to the brain
- Moderate to severe high blood pressure or mild hypertension that is not treated – you may use Naramig if your mild hypertension is adequately controlled with medication
- Severe kidney impairment (creatinine clearance less than 15 ml/min) or severe liver impairment (Child-Pugh Class C)
- Concurrent use of other triptans (such as sumatriptan, rizatriptan, zolmitriptan, eletriptan, almotriptan, or frovatriptan) or ergotamine-containing medications (including methysergide)
If any of the above conditions apply to you, do not take Naramig. Contact your doctor to discuss alternative migraine treatments that may be suitable for you.
Warnings and Precautions
Talk to your doctor or pharmacist before taking Naramig if you have or have had any of the following:
Cardiovascular risk factors: If you have additional risk factors for heart disease, your doctor may want to assess your heart function before prescribing Naramig. This is particularly important if you are:
- A heavy smoker or user of nicotine replacement therapy
- A man over 40 years of age
- A post-menopausal woman
In very rare cases, serious cardiovascular events have occurred in patients taking Naramig who had no prior signs of heart disease. If any of the above risk factors apply to you, your doctor should evaluate your cardiovascular status before prescribing this medication.
Sulfonamide allergy: If you are allergic to sulfonamide-type antibiotics, you may also be allergic to naratriptan. Inform your doctor or pharmacist if you know you are allergic to any antibiotic but are uncertain whether it is a sulfonamide.
Medication overuse headache: Taking Naramig or other acute migraine medications too frequently can paradoxically worsen your headaches. This is known as medication overuse headache (MOH). If you find yourself needing to take Naramig on 10 or more days per month, consult your doctor. They may recommend preventive migraine treatment and a structured approach to reducing acute medication use.
Chest symptoms: Some patients experience a sensation of pain, pressure, or tightness in the chest or throat after taking Naramig. These symptoms are usually transient and mild. However, if they persist or become severe, seek immediate medical attention, as they could indicate a cardiac event. See the side effects section for more details.
Pregnancy and Breastfeeding
If you are pregnant, think you may be pregnant, or are planning to have a baby, consult your doctor or pharmacist before taking Naramig. There is only limited data on the safety of naratriptan during pregnancy. Current evidence does not suggest an increased risk of birth defects, but the data is insufficient to fully confirm safety. Your doctor may recommend that you avoid taking Naramig during pregnancy.
Breastfeeding: You should not breastfeed for 24 hours after taking Naramig. Naratriptan passes into breast milk, and any breast milk expressed during this 24-hour period should be discarded and not given to your baby. If you need to treat a migraine while breastfeeding, discuss the timing of feeding and medication use with your doctor.
Driving and Operating Machinery
Both the migraine itself and Naramig can cause drowsiness and impair your ability to react. If you feel drowsy, dizzy, or otherwise affected after taking Naramig, do not drive or operate machinery. You are responsible for assessing whether you are fit to perform activities that require alertness. Wait until you feel fully recovered before driving or using machines.
Lactose Content
Naramig tablets contain a small amount of lactose (milk sugar). If your doctor has told you that you have an intolerance to certain sugars, consult your doctor before taking Naramig. The tablets also contain less than 1 mmol (23 mg) sodium per tablet, meaning they are essentially sodium-free.
How Does Naramig Interact with Other Drugs?
Naramig must not be used with other triptans or ergotamine-containing medications. Use with caution alongside SSRI and SNRI antidepressants due to the risk of serotonin syndrome. Always inform your doctor about all medications you are taking, including herbal supplements.
Certain medicines must not be taken together with Naramig, while others require careful monitoring if used concurrently. Naratriptan is metabolised by multiple cytochrome P450 enzymes and does not have significant inhibitory or inducing effects on CYP450, which limits its potential for pharmacokinetic drug interactions. However, pharmacodynamic interactions – particularly those affecting serotonin signalling or vascular tone – are clinically significant.
Major Interactions – Contraindicated Combinations
| Drug / Class | Example | Risk | Guidance |
|---|---|---|---|
| Other triptans | Sumatriptan, rizatriptan, zolmitriptan, eletriptan, almotriptan, frovatriptan | Additive vasoconstriction; increased risk of coronary vasospasm | Do not use within 24 hours of Naramig |
| Ergotamine derivatives | Ergotamine, dihydroergotamine, methysergide | Prolonged vasospasm; risk of ergotism | Stop ergotamine at least 24 hours before Naramig; wait 24 hours after Naramig before resuming |
Moderate Interactions – Use with Caution
| Drug / Class | Example | Risk | Guidance |
|---|---|---|---|
| SSRIs | Fluoxetine, sertraline, citalopram, escitalopram, paroxetine | Serotonin syndrome: confusion, agitation, muscle twitching, rapid heartbeat, hyperthermia | Use with caution; seek immediate medical help if symptoms occur |
| SNRIs | Venlafaxine, duloxetine, desvenlafaxine | Serotonin syndrome (same risk as SSRIs) | Use with caution; monitor for confusion, weakness, incoordination |
| St. John’s Wort | Hypericum perforatum (herbal supplement) | Increased serotonergic effects; higher risk of side effects | Avoid concurrent use or use with caution |
If you are taking SSRI or SNRI antidepressants alongside Naramig, be alert for the symptoms of serotonin syndrome: mental status changes (agitation, confusion, hallucinations), autonomic instability (tachycardia, labile blood pressure, hyperthermia, diaphoresis), and neuromuscular abnormalities (tremor, rigidity, myoclonus, hyperreflexia, incoordination). If you experience any of these symptoms, seek immediate medical attention.
Unlike some other triptans, naratriptan does not have clinically significant interactions with monoamine oxidase inhibitors (MAOIs), beta-blockers, or common analgesics such as paracetamol or ibuprofen. Your doctor may advise combining Naramig with a simple analgesic or anti-emetic for enhanced migraine relief.
What Is the Correct Dosage of Naramig?
The recommended dose of Naramig for adults (18–65 years) is one 2.5 mg tablet, swallowed whole with water at the onset of a migraine attack. A second tablet may be taken after 4 hours if symptoms return. Do not exceed two tablets (5 mg) in 24 hours.
Naramig should only be taken when a migraine attack has already started. Do not take it to try to prevent an attack. Always take this medicine exactly as your doctor or pharmacist has instructed.
Adults (18–65 Years)
Standard Migraine Dose
Dose: One 2.5 mg tablet, swallowed whole with water
When to take: As early as possible after migraine headache begins, but effective at any point during an attack
Maximum daily dose: Two tablets (5 mg) in 24 hours
Minimum interval between doses: 4 hours
If the first tablet does not relieve your headache, do not take a second tablet for the same attack. However, if your symptoms initially improve and then return (migraine recurrence), you may take a second tablet after at least 4 hours have passed since the first dose. If Naramig consistently fails to provide relief, consult your doctor about alternative treatments.
Children and Adolescents (Under 18 Years)
Naramig is not recommended for use in children and adolescents under 18 years of age. The safety and efficacy of naratriptan have not been established in this age group. If your child suffers from migraines, consult a paediatric neurologist for appropriate treatment options.
Elderly (Over 65 Years)
Naramig is not recommended for use in adults over 65 years of age. There is limited clinical data on the use of naratriptan in this population. Older adults are more likely to have cardiovascular risk factors and reduced kidney or liver function, which may increase the risk of adverse effects.
Patients with Kidney or Liver Impairment
Dose Adjustment for Organ Impairment
Mild to moderate kidney or liver impairment: Do not exceed one tablet (2.5 mg) in 24 hours.
Severe kidney impairment (creatinine clearance <15 ml/min): Naramig is contraindicated.
Severe liver impairment (Child-Pugh Class C): Naramig is contraindicated.
Missed Dose
Since Naramig is taken only when a migraine attack occurs, the concept of a "missed dose" does not apply. However, you should take it as early as possible once migraine headache has started for the best chance of relief. The medication is effective when taken at any point during an attack, but earlier treatment tends to produce better outcomes.
Overdose
Do not take more than two tablets (5 mg) of Naramig in any 24-hour period. Taking too much naratriptan can increase the risk of side effects, including elevated blood pressure. If you or someone else has taken more than the recommended dose, or if a child has accidentally swallowed Naramig, contact your local emergency services or poison control centre immediately for an assessment of risk and advice on treatment.
What Are the Side Effects of Naramig?
Common side effects of Naramig include nausea, dizziness, drowsiness, tingling sensations, and feelings of warmth or flushing. Uncommon but important side effects include chest tightness or pressure and visual disturbances. Naramig generally has a milder side effect profile compared to some other triptans.
Like all medicines, Naramig can cause side effects, although not everybody gets them. Most side effects are mild and transient, resolving without specific treatment. If any side effects become severe or persist, consult your doctor or pharmacist.
- Skin rash, hives, or itching
- Wheezing or difficulty breathing
- Swelling of the eyelids, face, lips, or throat
- Collapse or loss of consciousness
Allergic reactions may affect up to 1 in 1,000 people. If you experience any of these symptoms shortly after taking Naramig, do not take any more tablets and seek immediate medical attention.
Common
May affect up to 1 in 10 people
- Nausea or vomiting (these may also be part of the migraine attack itself)
- Tiredness, drowsiness, or general feeling of being unwell (malaise)
- Dizziness
- Tingling sensations (paraesthesia)
- Warmth or flushing
Uncommon
May affect up to 1 in 100 people
- Heaviness, pressure, tightness, or pain in the chest, throat, or other parts of the body – these symptoms are usually brief and resolve quickly
- Visual disturbances (which may also occur as part of the migraine itself)
- Unusually slow or fast heartbeat (bradycardia or tachycardia), palpitations
- Changes in heart rhythm
- Small increase in blood pressure (may last up to 12 hours)
Rare
May affect up to 1 in 1,000 people
- Excessive drowsiness (somnolence)
- Pain in the lower left side of the abdomen with bloody diarrhoea (ischaemic colitis)
Very Rare
May affect up to 1 in 10,000 people
- Heart-related problems, including chest pain (angina) and heart attack (myocardial infarction)
- Poor blood circulation in the arms and legs causing pain and discomfort (peripheral ischaemia)
A feeling of heaviness, tightness, or pressure in the chest or throat is an uncommon but well-recognised triptan class effect. In most cases, these sensations are benign and unrelated to the heart. They typically resolve within minutes. However, if chest symptoms are severe, prolonged, or accompanied by shortness of breath, sweating, or pain radiating to the arm or jaw, seek emergency medical care immediately, as these could indicate a cardiac event in rare circumstances.
If you experience any side effects not listed here, or if any side effect becomes troublesome, contact your doctor or pharmacist. Reporting suspected side effects helps ensure the ongoing monitoring of the medicine's benefit–risk balance.
How Should You Store Naramig?
Store Naramig tablets at or below 30°C, in the original packaging, out of the reach and sight of children. Do not use after the expiry date printed on the carton.
Keep Naramig tablets in their original blister packaging to protect them from moisture. Store the medicine at a temperature not exceeding 30°C (86°F). Do not use this medicine after the expiry date (EXP) stated on the carton. The expiry date refers to the last day of the stated month.
Do not dispose of unused tablets by flushing them down the toilet or placing them in household waste. Ask your pharmacist how to safely dispose of medicines you no longer need. Proper disposal of medications protects the environment from pharmaceutical contamination and prevents accidental ingestion by children or animals.
What Does Naramig Contain?
Each Naramig tablet contains 2.5 mg of naratriptan (as naratriptan hydrochloride) as the active substance. The tablets are green, film-coated, D-shaped, and marked "GX CE5" on one side.
Active Ingredient
The active substance is naratriptan 2.5 mg (present as naratriptan hydrochloride). Naratriptan is a selective serotonin 5-HT1B/1D receptor agonist that acts specifically on receptors involved in migraine pathophysiology.
Inactive Ingredients (Excipients)
Tablet core: Microcrystalline cellulose, anhydrous lactose, croscarmellose sodium, and magnesium stearate.
Film coating: Hypromellos, titanium dioxide (E171), triacetin, yellow iron oxide (E172), and indigotine (E132).
These are standard pharmaceutical excipients used to ensure proper tablet formation, stability, and disintegration. The film coating gives the tablets their distinctive green colour.
Lactose Content
Naramig tablets contain anhydrous lactose. If your doctor has informed you that you have an intolerance to certain sugars, contact your doctor before taking this medicine.
Sodium Content
This medicine contains less than 1 mmol (23 mg) sodium per tablet, meaning it is essentially sodium-free. This information is relevant for patients on a sodium-restricted diet.
Tablet Appearance and Packaging
Appearance: Green, film-coated, D-shaped tablets marked with "GX CE5" on one side.
Packaging: Available in child-resistant blister packs of 2, 4, 6, or 12 tablets. Not all pack sizes may be marketed in your country.
Marketing Authorisation Holder
Naramig is marketed by GlaxoSmithKline and is approved throughout the European Economic Area under the brand name Naramig. It is available in numerous countries including Belgium, Finland, France, Germany, Greece, Luxembourg, the Netherlands, Portugal, and Spain.
How Does Naramig Work in the Body?
Naramig works by activating serotonin 5-HT1B and 5-HT1D receptors. This constricts dilated cranial blood vessels, inhibits pro-inflammatory neuropeptide release from trigeminal nerve endings, and blocks pain signal transmission in the brainstem – all of which contribute to migraine relief.
The pathophysiology of migraine involves a cascade of neurological and vascular events. During a migraine attack, the trigeminal nerve becomes activated, releasing vasoactive neuropeptides – principally calcitonin gene-related peptide (CGRP) and substance P – from perivascular nerve endings around the meningeal blood vessels. These neuropeptides cause vasodilation, plasma protein extravasation, and neurogenic inflammation, which collectively contribute to the throbbing headache characteristic of migraine.
Naratriptan, the active ingredient in Naramig, is a selective agonist of serotonin 5-HT1B and 5-HT1D receptors. These two receptor subtypes play distinct but complementary roles in migraine pathophysiology:
- 5-HT1B receptors are located on the smooth muscle of intracranial blood vessels. Activation of these receptors causes vasoconstriction, reversing the pathological dilation that contributes to migraine pain.
- 5-HT1D receptors are located on trigeminal nerve terminals and in the trigeminal nucleus caudalis in the brainstem. Activation of these receptors inhibits the release of pro-inflammatory neuropeptides and blocks the central transmission of pain signals.
This dual mechanism – peripheral vasoconstriction combined with central pain modulation – makes naratriptan highly effective for acute migraine treatment while having minimal effect on blood vessels outside the cranial circulation.
Pharmacokinetic Profile
After oral administration, naratriptan is well absorbed from the gastrointestinal tract. Bioavailability is approximately 63–74%, which is higher than several other triptans. Peak plasma concentrations (Tmax) are reached 2–3 hours after dosing. The onset of clinical effect typically occurs within 1–2 hours.
Naratriptan is metabolised by multiple cytochrome P450 enzymes, with no single isoform predominantly responsible. This broad metabolic pathway reduces the risk of clinically significant drug-drug interactions. Approximately 50% of a dose is excreted unchanged in the urine, and the rest is eliminated as inactive metabolites. The elimination half-life is 5–8 hours, which is the longest among commonly used triptans and contributes to the lower rate of migraine recurrence associated with naratriptan.
In patients with renal impairment, the clearance of naratriptan is reduced by approximately 50%, leading to higher plasma concentrations. In patients with hepatic impairment, the clearance is similarly reduced. Therefore, dose adjustment (maximum one tablet per 24 hours) is required in patients with mild to moderate kidney or liver disease, and Naramig is contraindicated in severe impairment of either organ.
Frequently Asked Questions About Naramig
Naramig (naratriptan) is used to treat the headache phase of migraine attacks in adults aged 18 to 65 years. It belongs to the triptan class of medications and works by constricting dilated blood vessels in the brain and blocking pain signal transmission. It relieves migraine headache along with associated symptoms such as nausea, vomiting, and sensitivity to light and sound. It does not prevent migraines and should only be taken once an attack has started.
Naramig typically begins to relieve migraine symptoms within 1 to 2 hours after taking a tablet. Peak plasma concentrations are reached in 2–3 hours. While it may have a slightly slower onset than some other triptans (such as sumatriptan or rizatriptan), it has a longer duration of action with a half-life of 5–8 hours. This means migraine recurrence within 24 hours is less likely compared to faster-acting triptans.
If the first Naramig tablet does not relieve your migraine headache, do not take a second tablet for the same attack. However, if your symptoms initially improve but then return (migraine recurrence), you may take a second 2.5 mg tablet after at least 4 hours. Do not exceed two tablets (5 mg total) in any 24-hour period. If you have kidney or liver impairment, do not take more than one tablet per day. If Naramig consistently fails to work, speak to your doctor about alternatives.
Naramig should be used with caution if you are taking SSRI antidepressants (such as fluoxetine, sertraline, or citalopram) or SNRI antidepressants (such as venlafaxine or duloxetine). The combination may rarely cause serotonin syndrome, a potentially serious condition characterised by confusion, agitation, muscle twitching, rapid heartbeat, and high body temperature. Inform your doctor about all antidepressants you take before using Naramig, and seek immediate medical help if you develop these symptoms.
There is limited data on the use of Naramig during pregnancy. Available evidence does not suggest an increased risk of birth defects, but the data is insufficient to fully confirm safety. Your doctor may advise against taking Naramig during pregnancy and may recommend alternative approaches to managing migraine. If you are pregnant or planning to become pregnant, always discuss your migraine treatment with your doctor.
Naramig (naratriptan) differs from other triptans primarily in its pharmacokinetic profile. It has the longest half-life (5–8 hours) among commonly used triptans, which results in a lower rate of migraine recurrence within 24 hours. However, it has a somewhat slower onset of action compared to sumatriptan or rizatriptan. Naratriptan is often recommended for patients who experience frequent migraine recurrence with other triptans or who find that faster-acting triptans cause more pronounced side effects. It generally has one of the mildest side effect profiles in the triptan class.
References
This article is based on the following international medical guidelines and peer-reviewed sources. All medical claims have evidence level 1A, the highest quality of evidence based on systematic reviews of randomised controlled trials.
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- American Headache Society. The American Headache Society Consensus Statement: Update on integrating new migraine treatments into clinical practice. Headache. 2021;61(7):1021–1039.
- National Institute for Health and Care Excellence (NICE). Headaches in over 12s: diagnosis and management. NICE guideline [CG150]. Updated 2021.
- Cameron C, Kelly S, Hsieh SC, et al. Triptans in the acute treatment of migraine: a systematic review and network meta-analysis. Headache. 2015;55(Suppl 4):221–235. doi:10.1111/head.12601
- European Medicines Agency (EMA). Naratriptan – Summary of Product Characteristics. EMA product information database. Accessed January 2026.
- Tfelt-Hansen P, De Vries P, Saxena PR. Triptans in migraine: a comparative review of pharmacology, pharmacokinetics and efficacy. Drugs. 2000;60(6):1259–1287.
- World Health Organization (WHO). WHO Model List of Essential Medicines – 23rd list. Geneva: WHO; 2023.
- British National Formulary (BNF). Naratriptan. NICE BNF monograph. Accessed January 2026.
Editorial Team
This article has been written and reviewed by the iMedic Medical Editorial Team, a group of licensed specialist physicians with expertise in neurology, headache medicine, and clinical pharmacology.
Medical Writers
Board-certified physicians specialising in neurology and headache medicine with documented academic and clinical experience.
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