Relpax: Uses, Dosage & Side Effects
A selective serotonin receptor agonist (triptan) for the acute treatment of migraine headaches with or without aura in adults
Relpax (eletriptan) is a prescription medication belonging to the triptan class of drugs, used for the acute treatment of migraine headaches with or without aura in adults. It works as a selective serotonin (5-HT1B/1D) receptor agonist, constricting dilated intracranial blood vessels and inhibiting the release of pro-inflammatory neuropeptides from trigeminal nerve endings. Relpax is taken as an oral tablet at the onset of migraine headache, with the standard dose being 40 mg. It is not intended for migraine prevention. Clinical trials have demonstrated that eletriptan provides rapid and effective relief from migraine pain, with many patients experiencing significant improvement within 2 hours of dosing.
Quick Facts: Relpax
Key Takeaways
- Relpax (eletriptan) is a selective serotonin (5-HT1B/1D) receptor agonist used exclusively for the acute treatment of migraine attacks with or without aura in adults — it is not a preventive medication.
- The standard starting dose is 40 mg taken orally at migraine onset; a second 40 mg dose may be taken after at least 2 hours if the headache returns, up to a maximum of 80 mg per 24 hours.
- Relpax must not be used in patients with cardiovascular disease (including coronary artery disease, stroke, or peripheral vascular disease), uncontrolled hypertension, or severe hepatic or renal impairment.
- Significant drug interactions exist with strong CYP3A4 inhibitors (such as ketoconazole, erythromycin, and HIV protease inhibitors), other triptans, and ergotamine-type medications — these must not be used within 24 hours of Relpax.
- The most common side effects are chest tightness, dizziness, drowsiness, nausea, and muscle weakness; patients should avoid driving or operating machinery during a migraine or after taking Relpax.
What Is Relpax and What Is It Used For?
Relpax contains the active substance eletriptan (as eletriptan hydrobromide), a member of the triptan class of antimigraine drugs. Triptans are selective serotonin (5-hydroxytryptamine, 5-HT) receptor agonists that specifically target the 5-HT1B and 5-HT1D receptor subtypes. These receptors are predominantly located on intracranial blood vessels and on the presynaptic terminals of trigeminal sensory neurons. By selectively activating these receptors, eletriptan addresses the key pathophysiological mechanisms of migraine without the broad cardiovascular effects seen with earlier, less selective antimigraine agents such as ergotamine.
The pathophysiology of migraine involves a complex cascade of neurovascular events. During a migraine attack, the trigeminal nerve releases vasoactive neuropeptides — including calcitonin gene-related peptide (CGRP), substance P, and neurokinin A — from perivascular nerve endings surrounding meningeal and cerebral blood vessels. These neuropeptides cause vasodilation of intracranial arteries, plasma protein extravasation, and neurogenic inflammation in the meningeal tissues, resulting in the characteristic throbbing headache of migraine. Additionally, sensitization of central pain-processing neurons in the trigeminal nucleus caudalis and higher brain centers amplifies the pain signal, contributing to the severity and duration of attacks.
Eletriptan exerts its therapeutic effect through three complementary mechanisms. First, by activating 5-HT1B receptors on smooth muscle cells of dilated cranial blood vessels, it causes vasoconstriction, restoring normal vessel caliber and reducing the pulsatile blood flow that contributes to headache pain. Second, by activating 5-HT1D receptors on presynaptic trigeminal nerve terminals, eletriptan inhibits the release of pro-inflammatory neuropeptides, thereby reducing neurogenic inflammation and plasma protein extravasation. Third, there is evidence that triptans may also modulate pain signal transmission at the level of the trigeminal nucleus caudalis in the brainstem, providing an additional mechanism of pain relief.
Relpax is indicated for the acute treatment of migraine headaches with or without aura in adults. It is important to understand that Relpax is designed to treat migraine attacks that have already begun — specifically during the headache phase. It should not be taken during the aura phase before the headache starts, and it is not used for the prevention of migraine attacks. Patients who experience frequent migraines requiring acute treatment on many days per month should discuss preventive treatment options with their healthcare provider.
Before a migraine attack, some patients experience an aura phase, which may include visual disturbances (such as flashing lights, zigzag patterns, or blind spots), numbness or tingling in the face or hands, and speech difficulties. These symptoms typically last 20 to 60 minutes and are followed by the headache phase. Relpax should be taken once the headache phase has begun, not during the aura. Taking the tablet as early as possible after headache onset generally leads to better outcomes.
Eletriptan was first approved by the U.S. Food and Drug Administration (FDA) in 2002 and by the European Medicines Agency (EMA) shortly thereafter. It is now available in numerous countries worldwide and has been extensively studied in clinical trials. In pivotal clinical studies, eletriptan 40 mg demonstrated statistically significant superiority over placebo for the primary endpoint of headache response (reduction from moderate or severe pain to mild or no pain) at 2 hours post-dose. In the largest phase III trial, approximately 65% of patients treated with eletriptan 40 mg achieved headache response at 2 hours compared with approximately 22% of placebo-treated patients. Pain-free rates at 2 hours were approximately 34% for eletriptan 40 mg versus 4% for placebo.
Relpax is an acute (abortive) migraine treatment, meaning it is taken when a migraine attack occurs to relieve symptoms. It is fundamentally different from preventive migraine therapies (such as beta-blockers, anticonvulsants, CGRP monoclonal antibodies, or botulinum toxin), which are taken regularly to reduce the frequency and severity of future attacks. If you experience migraines on 4 or more days per month, your doctor may recommend adding a preventive therapy alongside your acute treatment.
What Should You Know Before Taking Relpax?
Contraindications
Relpax is contraindicated — meaning it must not be used — in several clearly defined clinical situations. These contraindications exist because eletriptan, like all triptans, causes vasoconstriction, and its use in patients with compromised cardiovascular function could potentially precipitate serious and potentially life-threatening events. Before prescribing Relpax, your physician should conduct a thorough cardiovascular assessment, particularly if you have risk factors for heart disease.
Do not take Relpax if any of the following apply to you:
- Allergy: You are allergic to eletriptan or any of the other ingredients in the tablet (including lactose monohydrate, microcrystalline cellulose, croscarmellose sodium, magnesium stearate, titanium dioxide, hypromellose, glycerol triacetate, or the coloring agent sunset yellow FCF [E110]).
- Severe hepatic impairment: Eletriptan is extensively metabolized by the liver via the CYP3A4 enzyme system, and severe liver disease significantly impairs drug clearance, leading to dangerously elevated blood levels.
- Severe renal impairment: Patients with severe kidney disease may experience accumulation of the drug and its metabolites.
- Uncontrolled or moderately to severely elevated blood pressure: The vasoconstrictive effects of eletriptan could exacerbate hypertension, increasing the risk of hypertensive crisis.
- History of cardiovascular disease: This includes coronary artery disease (including history of heart attack or angina), heart failure, clinically significant cardiac arrhythmias, or Prinzmetal angina (coronary artery vasospasm).
- Peripheral vascular disease: Eletriptan can cause vasoconstriction in peripheral blood vessels and should not be used in patients with poor circulation.
- History of stroke or transient ischemic attack (TIA): Even mild or brief cerebrovascular events in the past are a contraindication.
- Within 24 hours of ergotamine or other triptans: Concurrent use of eletriptan with ergotamine-type drugs (such as ergotamine, dihydroergotamine, or methysergide) or with other triptans (such as sumatriptan, rizatriptan, naratriptan, zolmitriptan, almotriptan, or frovatriptan) is contraindicated due to the additive vasoconstrictive effects, which could lead to coronary artery vasospasm.
Warnings and Precautions
Talk to your doctor before taking Relpax if you have any cardiovascular risk factors, including diabetes, smoking or nicotine replacement therapy, being male and over 40 years of age, being a postmenopausal woman, or having a family history of coronary artery disease. Your doctor may wish to perform a cardiovascular evaluation before your first dose.
Even if Relpax is not strictly contraindicated, certain conditions warrant special caution and discussion with your doctor. These include patients who are at increased risk for cardiovascular disease but who have not yet been diagnosed with it. For such patients, the prescribing physician may consider administering the first dose under medical supervision to monitor for cardiac effects.
Additionally, patients should be aware that repeated, frequent use of Relpax or any acute migraine medication over several days or weeks can lead to medication-overuse headache (MOH), a condition where daily or near-daily headache develops as a consequence of chronic analgesic or triptan use. If you find that your headaches are becoming more frequent or that Relpax is becoming less effective, inform your doctor, as you may need to discontinue the medication temporarily under medical supervision.
Pregnancy and Breastfeeding
If you are pregnant, think you may be pregnant, or are planning to become pregnant, consult your doctor before using Relpax. The effects of eletriptan on human pregnancy have not been adequately studied. Animal reproductive toxicology studies have not demonstrated teratogenic effects, but as with all medications, Relpax should be used during pregnancy only when the potential benefit to the mother justifies the potential risk to the fetus.
Eletriptan is excreted in human breast milk. Following a single 80 mg oral dose, eletriptan has been detected in breast milk with an average milk-to-plasma ratio of approximately 1:4. Based on this data, breastfeeding should be avoided for at least 24 hours after treatment with Relpax. The decision to breastfeed while using Relpax should be made in consultation with your healthcare provider, weighing the benefits of breastfeeding against the potential risk of drug exposure to the infant.
Driving and Operating Machinery
Both migraine itself and Relpax can cause drowsiness and dizziness. This medication may impair your ability to perform tasks that require full alertness, such as driving a vehicle or operating heavy machinery. Do not drive or operate machinery during a migraine attack or after taking Relpax if you feel drowsy, dizzy, or otherwise impaired. Wait until you have fully recovered before resuming such activities.
Important Information About Ingredients
Relpax tablets contain lactose monohydrate. If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicine. The tablets also contain the coloring agent sunset yellow FCF (E110), which may cause allergic reactions in susceptible individuals. Relpax 20 mg and 40 mg tablets contain less than 1 mmol (23 mg) of sodium per tablet, meaning they are essentially sodium-free.
How Does Relpax Interact with Other Drugs?
Drug interactions with Relpax are clinically important because eletriptan is primarily metabolized by the cytochrome P450 3A4 (CYP3A4) enzyme system in the liver. Medications that inhibit CYP3A4 can significantly increase plasma concentrations of eletriptan, potentially increasing the risk of adverse effects, including cardiovascular events. Conversely, potent CYP3A4 inducers may reduce eletriptan levels and decrease its efficacy.
Pharmacokinetic studies have demonstrated that co-administration of eletriptan with the potent CYP3A4 inhibitor ketoconazole resulted in a nearly 6-fold increase in the area under the plasma concentration-time curve (AUC) and a 2-fold increase in the maximum plasma concentration (Cmax) of eletriptan. Similarly, erythromycin increased eletriptan AUC by approximately 2-fold. These interactions are of sufficient magnitude to warrant absolute avoidance of certain drug combinations.
Major Interactions (Avoid Combination)
| Drug / Class | Interaction | Clinical Significance |
|---|---|---|
| Other triptans (sumatriptan, rizatriptan, naratriptan, zolmitriptan, almotriptan, frovatriptan) | Additive vasoconstrictive effects | Do not use within 24 hours of Relpax. Risk of coronary vasospasm. |
| Ergotamine and ergot derivatives (dihydroergotamine, methysergide) | Additive vasoconstrictive effects | Do not use within 24 hours of Relpax. Risk of prolonged vasospasm. |
| Ketoconazole, itraconazole (azole antifungals) | Potent CYP3A4 inhibition; ~6-fold increase in eletriptan AUC | Contraindicated. Dramatically increases risk of adverse cardiovascular effects. |
| Ritonavir, indinavir, nelfinavir (HIV protease inhibitors) | Strong CYP3A4 inhibition; significant increase in eletriptan levels | Contraindicated. Risk of toxicity and cardiovascular events. |
| Erythromycin, clarithromycin, josamycin (macrolide antibiotics) | Moderate CYP3A4 inhibition; ~2-fold increase in eletriptan AUC | Avoid combination. If used together, close monitoring required. |
Moderate Interactions (Use with Caution)
| Drug / Class | Interaction | Clinical Significance |
|---|---|---|
| SSRIs (fluoxetine, sertraline, paroxetine, citalopram, escitalopram) | Combined serotonergic activity may increase risk of serotonin syndrome | Discuss with doctor before combining. Monitor for serotonin syndrome symptoms. |
| SNRIs (venlafaxine, duloxetine, desvenlafaxine) | Combined serotonergic activity may increase risk of serotonin syndrome | Discuss with doctor before combining. Monitor for serotonin syndrome symptoms. |
| St. John’s Wort (Hypericum perforatum) | Serotonergic herb; may increase risk of serotonin syndrome | Should not be taken concurrently. Consult doctor before stopping St. John’s Wort. |
Serotonin syndrome is a potentially life-threatening condition that can occur when Relpax is used in combination with serotonergic drugs such as SSRIs, SNRIs, or St. John’s Wort. Symptoms include agitation, hallucinations, rapid heartbeat, elevated body temperature, rapid changes in blood pressure, loss of coordination, and overactive reflexes. Seek emergency medical attention immediately if you experience these symptoms after taking Relpax with another serotonergic medication.
What Is the Correct Dosage of Relpax?
Always use Relpax exactly as your doctor has prescribed. Do not change the dose without consulting your doctor or pharmacist. Relpax is designed for acute treatment — take it only when a migraine headache has started, not to prevent attacks. The following dosage guidelines apply:
Adults
Standard Adult Dosage
The recommended starting dose is 40 mg, taken as a single oral tablet at the onset of the migraine headache. Swallow the tablet whole with water. Relpax can be taken with or without food.
- First dose did not work: If the migraine has not improved after the first tablet, do not take a second tablet for the same attack.
- Migraine returns: If the headache improves after the first tablet but then comes back, you may take a second 40 mg tablet, but wait at least 2 hours after the first dose.
- Maximum daily dose: Do not exceed 80 mg (two 40 mg tablets) within any 24-hour period.
- Dose adjustment: If you find that a single 40 mg tablet does not provide sufficient relief for your migraines, discuss with your doctor whether increasing the dose to 80 mg as a single initial dose may be appropriate for future attacks. Some patients may benefit from the 20 mg strength as a starting dose.
Children and Adolescents
Pediatric Use
Relpax is not recommended for children and adolescents under 18 years of age. The safety and efficacy of eletriptan have not been established in this population. Migraine treatment in children requires a different approach, and parents or guardians should consult a pediatrician or pediatric neurologist for appropriate treatment options.
Elderly Patients
Use in Patients Over 65
Relpax is not recommended for patients over 65 years of age. The safety and efficacy of eletriptan in elderly patients have not been sufficiently studied. Older adults are generally at higher risk for cardiovascular disease, which is a contraindication to triptan use. If you are over 65, discuss alternative migraine treatment options with your doctor.
Patients with Kidney Problems
Renal Impairment Dosing
Relpax can be used by patients with mild to moderate kidney problems, but a reduced starting dose of 20 mg is recommended. The total daily dose should not exceed 40 mg. Your doctor will advise you on the appropriate dose based on your kidney function test results. Relpax is contraindicated in patients with severe kidney disease.
Patients with Liver Problems
Hepatic Impairment Dosing
Relpax can be used by patients with mild to moderate liver problems without dose adjustment. No change in starting dose is required for mild to moderate hepatic impairment. Relpax is contraindicated in patients with severe liver disease, as eletriptan is extensively metabolized by hepatic CYP3A4 and impaired clearance could lead to dangerously high blood levels.
Missed Dose
Since Relpax is taken as needed when a migraine attack occurs (not on a scheduled basis), the concept of a missed dose does not strictly apply. However, for optimal results, take the tablet as soon as possible after the migraine headache begins. The medication is most effective when taken early in the headache phase. If you forget to take a dose during an attack, take it as soon as you remember, provided the headache is still present and it has been less than 24 hours since the onset.
Overdose
If you have taken more Relpax than prescribed, or if a child has accidentally ingested the medication, seek immediate medical attention or contact your local poison control center. Take the medication packaging with you, even if no tablets remain. Symptoms of overdose may include elevated blood pressure and cardiovascular problems. There is no specific antidote for eletriptan overdose; treatment is supportive and symptomatic with monitoring for at least 20 hours, as the elimination half-life of eletriptan is approximately 4 hours.
| Patient Group | Starting Dose | Maximum 24h Dose | Notes |
|---|---|---|---|
| Adults (18–65 years) | 40 mg | 80 mg | Second dose after ≥2 hours only if migraine returns |
| Mild–moderate renal impairment | 20 mg | 40 mg | Doctor determines dose based on kidney function |
| Mild–moderate hepatic impairment | 40 mg | 80 mg | No dose adjustment needed |
| Children (<18 years) | Not recommended | — | Safety and efficacy not established |
| Elderly (>65 years) | Not recommended | — | Higher cardiovascular risk |
What Are the Side Effects of Relpax?
Like all medicines, Relpax can cause side effects, although not everyone who takes it will experience them. The safety profile of eletriptan has been extensively characterized through multiple clinical trials involving thousands of patients and through decades of post-marketing surveillance data. Most side effects are mild to moderate in intensity and resolve on their own without specific treatment.
It is important to distinguish between the symptoms of migraine itself (which can include nausea, sensitivity to light and sound, and fatigue) and side effects caused by the medication. Some symptoms commonly reported during clinical trials — such as nausea, dizziness, and drowsiness — may be attributable to the underlying migraine rather than to eletriptan itself.
Tell your doctor immediately if you experience any of the following after taking Relpax: sudden wheezing, difficulty breathing, swelling of eyelids, lips or face, skin rash or itching (especially spreading over the body) — these may be signs of a severe allergic reaction. Also seek immediate help for tightness, pressure, or pain in the chest or throat that may be intense — these could be symptoms of ischemic heart disease. Signs of serotonin syndrome include agitation, hallucinations, loss of coordination, rapid heartbeat, elevated body temperature, rapid blood pressure changes, and overactive reflexes.
Common
May affect up to 1 in 10 people
- Chest pressure, pain, or tightness; palpitations; increased heart rate
- Dizziness, vertigo, headache, drowsiness
- Decreased sensation or pain upon touch (hypoesthesia)
- Throat tightness, sore throat, dry mouth
- Abdominal pain, indigestion, nausea, vomiting
- Muscle stiffness (increased muscle tone), muscle weakness, back pain, muscle pain
- General weakness (asthenia), warmth sensation, chills, sweating
- Tingling or abnormal sensation (paresthesia), flushing, pain, runny nose
Uncommon
May affect up to 1 in 100 people
- Difficulty breathing, yawning
- Facial swelling, swelling of hands and feet, tongue inflammation, skin rash, itching
- Increased sensitivity to touch (hyperesthesia), coordination problems, slow movements, tremor, speech difficulties
- Depression, depersonalization, unusual thoughts, agitation, confusion, mood changes (euphoria), periods of apathy, general malaise, insomnia
- Loss of appetite, taste changes, thirst
- Joint problems (osteoarthritis), bone pain, joint pain
- Urinary problems, increased urination, diarrhea
- Visual disturbances, eye pain, sensitivity to light, dry or watery eyes
- Ear pain, tinnitus (ringing in the ears)
- Peripheral vascular disturbances (poor circulation)
Rare
May affect up to 1 in 1,000 people
- Shock, asthma, urticaria (hives), skin changes, swollen tongue
- Throat or chest infection, swollen lymph nodes
- Slow heart rate (bradycardia)
- Emotional disturbances (mood swings)
- Arthritis, muscle disorder, muscle twitching
- Constipation, esophageal inflammation, acid reflux
- Chest pain, heavy or prolonged menstruation
- Eye infection (conjunctivitis), voice changes
Other Reported Side Effects
Frequency not precisely determined (post-marketing reports)
- Fainting, high blood pressure
- Colitis (inflammation of the colon), vomiting
- Cerebrovascular events (stroke-like symptoms)
- Insufficient blood flow to the heart (myocardial ischemia)
- Heart attack (myocardial infarction)
- Coronary artery spasm
- Elevated liver enzymes (detected on blood tests)
The cardiovascular side effects of triptans, including chest tightness and pressure, are among the most concerning to patients. It is important to know that "triptan sensations" — feelings of tightness, pressure, or heaviness in the chest, throat, or jaw — are reported by approximately 2–5% of patients taking triptans. In most cases, these sensations are not related to actual cardiac ischemia and are thought to result from esophageal smooth muscle contraction or skeletal muscle effects. However, because these symptoms can mimic angina, patients experiencing chest pain after taking Relpax should seek medical evaluation, especially if they have cardiovascular risk factors.
Long-term safety data and decades of real-world use support the overall favorable safety profile of eletriptan when used appropriately in patients without cardiovascular contraindications. The most important safety measure is ensuring that Relpax is prescribed only to patients who have been properly evaluated for cardiovascular risk and who do not have contraindications to its use.
Using Relpax or any acute headache medication too frequently (typically on 10 or more days per month over several months) can paradoxically lead to more frequent headaches known as medication-overuse headache (MOH). If you notice that your headaches are becoming more frequent, tell your doctor. You may need to temporarily discontinue the medication under medical supervision to break the cycle.
How Should You Store Relpax?
Proper storage ensures that Relpax tablets maintain their quality, safety, and effectiveness throughout their shelf life. Follow these guidelines carefully:
- Keep out of reach of children: Store Relpax in a secure location where children cannot access it.
- Check expiration date: Do not use Relpax after the expiration date printed on the packaging. The expiration date refers to the last day of the indicated month.
- Blister pack storage: PVC/Aclar/aluminum blister packs do not require any special storage conditions. Store at room temperature.
- HDPE bottle storage: If your Relpax comes in a high-density polyethylene (HDPE) plastic bottle, keep the tablets in the original container and close the bottle tightly after each use. The tablets are moisture-sensitive, so protecting them from humidity is important.
- Proper disposal: Do not dispose of unused or expired Relpax tablets in household waste or down the drain. Ask your pharmacist about proper medication disposal methods to protect the environment.
When traveling with Relpax, keep the tablets in their original packaging to protect them from moisture and light. There are no temperature restrictions for short-term travel, as the blister pack formulation is designed for standard room temperature storage. If you carry Relpax as part of a migraine emergency kit, ensure that you regularly check the expiration date and replace tablets before they expire.
What Does Relpax Contain?
Understanding the composition of your medication is important, particularly if you have known allergies or sensitivities to specific pharmaceutical ingredients. Below is a detailed breakdown of the composition of Relpax.
Active Ingredient
The active substance is eletriptan, present in the form of eletriptan hydrobromide. Each 20 mg film-coated tablet contains 20 mg of eletriptan (as eletriptan hydrobromide). Each 40 mg film-coated tablet contains 40 mg of eletriptan (as eletriptan hydrobromide). Eletriptan is a second-generation triptan that was specifically developed for the acute treatment of migraine, with improved oral bioavailability and a rapid onset of action compared to some earlier triptans.
Inactive Ingredients (Excipients)
| Ingredient | Role | Notes |
|---|---|---|
| Eletriptan hydrobromide | Active substance | 20 mg or 40 mg per tablet |
| Microcrystalline cellulose | Binder / filler | Provides tablet structure |
| Lactose monohydrate | Filler / diluent | May affect patients with lactose intolerance |
| Croscarmellose sodium | Disintegrant | Helps tablet dissolve |
| Magnesium stearate | Lubricant | Aids manufacturing process |
| Titanium dioxide (E171) | Film-coating colorant | White pigment in coating |
| Hypromellos | Film-coating agent | Forms protective film |
| Glycerol triacetate | Plasticizer | Film-coating flexibility |
| Sunset yellow FCF (E110) | Colorant | May cause allergic reactions in susceptible individuals |
Appearance and Pack Sizes
Relpax tablets are orange, round, film-coated tablets. The 20 mg tablets are marked "VLE" on one side and "REP 20" on the other. The 40 mg tablets are marked "VLE" on one side and "REP 40" on the other. Relpax is available in transparent PVC/Aclar/aluminum blister packs containing 2, 3, 4, 5, 6, 10, 18, 30, or 100 tablets, or in HDPE plastic bottles with child-resistant caps containing 30 or 100 tablets. Not all pack sizes may be marketed in every country.
Frequently Asked Questions About Relpax
Relpax (eletriptan) is one of seven triptans available for acute migraine treatment. While all triptans work through the same mechanism (5-HT1B/1D receptor agonism), they differ in their pharmacokinetic properties. Eletriptan has a relatively rapid onset of action (peak levels at 1–2 hours) and an intermediate half-life of approximately 4 hours. Comparative clinical trials have suggested that eletriptan 40 mg may provide superior 2-hour headache response rates compared with sumatriptan 100 mg and rizatriptan 10 mg, though individual patient responses vary. The choice of triptan is typically based on factors such as speed of onset, consistency of response, tolerability, and patient preference.
Yes, Relpax can generally be taken alongside simple analgesics such as paracetamol (acetaminophen) or non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen. In fact, some clinical evidence suggests that combining a triptan with an NSAID may provide better migraine relief than either medication alone. However, always confirm with your doctor or pharmacist that this combination is appropriate for your individual circumstances, and avoid regular concurrent use to reduce the risk of medication-overuse headache.
Relpax should be used only when a migraine attack occurs and is limited to a maximum of 80 mg (two 40 mg tablets) per 24-hour period. There is no strict limit on the number of attacks you can treat per month, but using any acute migraine medication on 10 or more days per month for three or more consecutive months may lead to medication-overuse headache. If you find you need Relpax frequently, discuss preventive migraine therapy options with your doctor to reduce your overall migraine frequency.
Weight gain is not a recognized side effect of Relpax. Since triptans are used on an as-needed basis (typically only a few times per month) rather than daily, they are unlikely to cause sustained metabolic changes. Some patients may experience temporary appetite changes or nausea during a migraine attack or after taking the medication, but these effects are transient and not associated with long-term weight changes.
There are no specific drug interactions between Relpax and alcohol. However, alcohol is a common migraine trigger for many people, and consuming alcohol during a migraine attack may worsen symptoms such as nausea, vomiting, and headache. Additionally, both alcohol and Relpax can cause drowsiness and dizziness, so combining them may amplify these effects and impair your ability to drive or operate machinery. It is generally advisable to avoid alcohol during a migraine attack.
If Relpax does not adequately relieve your migraine attacks, discuss this with your doctor. Several options may be considered: trying a higher dose (80 mg as a single initial dose if you have been using 40 mg), switching to a different triptan, combining Relpax with an NSAID, or adding a preventive medication to reduce migraine frequency. It is important to give each triptan an adequate trial (at least 2–3 attacks) before concluding it is ineffective, as response can vary from attack to attack.
References
- European Medicines Agency (EMA). Relpax – Summary of Product Characteristics. Last updated 2024. Available from EMA product database.
- U.S. Food and Drug Administration (FDA). Relpax (eletriptan hydrobromide) – Prescribing Information. Revised 2023. Available from FDA Drugs@FDA database.
- American Headache Society (AHS). Consensus Statement: The Acute Treatment of Migraine in Adults. Headache. 2021;61(7):1021–1039.
- European Headache Federation (EHF). Guideline on the use of triptans for the acute treatment of migraine attacks. J Headache Pain. 2023;24:38.
- Goadsby PJ, Ferrari MD, Olesen J, et al. Eletriptan in acute migraine: a double-blind, placebo-controlled comparison to sumatriptan. Neurology. 2000;54(1):156–163.
- Mathew NT, Finlayson G, Smith TR, et al. Early intervention with eletriptan 40 mg for the acute treatment of migraine. Headache. 2006;46(1):57–63.
- Diener HC, Ryan R, Sun W, Hettiarachchi J. The 40-mg dose of eletriptan: Comparative efficacy and tolerability versus sumatriptan 100 mg. Eur J Neurol. 2004;11(2):125–134.
- World Health Organization (WHO). Model List of Essential Medicines – 23rd List, 2023. Geneva: World Health Organization.
- British National Formulary (BNF). Eletriptan. Available from NICE Evidence Services. Last updated 2025.
- Ferrari MD, Roon KI, Lipton RB, Goadsby PJ. Oral triptans (serotonin 5-HT1B/1D agonists) in acute migraine treatment: a meta-analysis of 53 trials. Lancet. 2001;358(9294):1668–1675.
Medical Editorial Team
Medical Content
Written by specialist physicians in neurology and clinical pharmacology with expertise in headache medicine and drug safety.
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Reviewed by the iMedic Medical Review Board according to international guidelines from EMA, FDA, WHO, and AHS.
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All medical claims based on Level 1A evidence from systematic reviews and randomized controlled trials, following the GRADE framework.
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For questions about this article, contact our medical team at iMedic Contact. Report any concerns about medication side effects to your national pharmacovigilance authority.