What is it used for?

• Relieving migraine headaches.

How does it work?

• Naramig tablets contain the active ingredient naratriptan, which is a type of medicine called a serotonin (or 5HT) agonist. This type of medicine is also commonly known as a 'triptan'. It is a painkiller specifically used to relieve migraine attacks.
• Although the cause of migraine attacks is not fully understood, it is thought that widening of blood vessels in the brain causes the throbbing pain of migraine headaches. Naratriptan relieves this pain by causing the blood vessels in the brain to narrow.
• Naratriptan works by stimulating receptors called serotonin (or 5HT) receptors that are found in the brain. A natural substance called serotonin normally acts on these receptors, causing blood vessels in the brain to narrow. Naratriptan mimics this action of serotonin by directly stimulating the serotonin receptors in the brain. This narrows the blood vessels and so relieves the pain of migraine headaches.
• The dose of naratriptan should be taken as early as possible after the migraine headache has started, though it is also effective if taken at a later stage during the migraine attack.

Key points Summary:

• This medicine should not be used to prevent migraines.
• This medicine should only be used by people with a clear diagnosis of migraine from their doctor.
• If the first dose of this medicine doesn't relieve your migraine headache then you should NOT take another dose for the same attack, as this has not been shown to be effective. (You can still take Naramig for your next attack.) If the first dose does initially relieve your migraine, but the headache then comes back, you can take a second dose. However, if you need a second dose because your migraine has returned, you should NOT take it within four hours of your first dose. Do not take more than two doses in 24 hours.
• Do not exceed the recommended dose.
• This medicine may cause drowsiness. If affected do not drive or operate machinery.

Use with caution in

• Allergy to medicines from the sulphonamide group, eg the antibiotic sulfamethoxazole.
• Decreased kidney function.
• Decreased liver function.
• People with risk factors for coronary heart disease, such as smoking, high cholesterol levels, high blood pressure (hypertension), diabetes, obesity, or a family history of heart disease.
• Men over 40 years of age.
• Post-menopausal women.

Not to be used in

• Severely decreased kidney function.
• Severely decreased liver function.
• People who have had a heart attack.
• Heart disease caused by inadequate blood flow to the heart (ischaemic heart disease), eg angina.
• A severe form of angina pectoris, not caused by exertion (Prinzmetal's angina).
• Narrowing of blood vessels in the extremities (peripheral vascular disease).
• Uncontrolled high blood pressure (hypertension).
• People who have had a stroke.
• History of small temporary strokes (transient ischaemic attacks).
• A form of migraine associated with paralysis of the eye muscles (ophthalmoplegic migraine).
• A form of migraine associated with temporary paralysis of one side of the body (hemiplegic migraine).
• A type of migraine where there is a disturbance in brain function which initially presents with total blindness followed by dizziness, speach disturbances, ringing in the ears and double vision (basilar migraine).
• This medicine is not recommended for children or adolescents under 18 years of age, or people over 65 years of age, as its safety and effectiveness have not been established in these age groups.

This medicine should not be used if you are allergic to one or any of its ingredients. 

Pregnancy and breastfeeding

• The safety of this medicine for use during pregnancy has not been established. It is not recommended for use during pregnancy, unless considered essential by your doctor. Seek medical advice from your doctor.
• This medicine may pass into breast milk. It should be used with caution by breastfeeding mothers, and only if the expected benefit to the mother is greater than any possible risk to the nursing infant. Seek medical advice from your doctor.

Side effects

• Tingling, pain, or sensation of heat in any part of the body, including the chest or throat.
• Drowsiness.
• Dizziness.
• Nausea and vomiting.
• Fatigue.
• General feeling of being unwell (malaise).
• Sensations of heaviness, pressure or tightness in any part of the body, including the chest or throat.
• Visual disturbances.
• Awareness of your heartbeat (palpitations).
• Increase or decrease in heart rate.

The side effects listed above may not include all of the side effects reported by the medicine's manufacturer.

How can this medicine affect other medicines?

It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while taking this one, to ensure that the combination is safe.

This medicine must not be taken in combination with ergotamine or its derivatives, eg dihydroergotamine or methysergide, or with other 5HT agonists (triptans), eg sumatriptan, zolmitriptan, frovatriptan, eletriptan, almotriptan.

If your first dose of naratriptan does not work to relieve your migraine, it is fine to take a painkiller containing aspirin, paracetamol, or a non-steroidal anti-inflammatory drug (NSAID), such as ibuprofen. However, as noted above, you should not take ergotamine, dihydroergotamine, methysergide or another triptan medicine.

There may be an increased risk of a rare side effect called the serotonin syndrome if naratriptan is taken in combination with other medicines that enhance the activity of serotonin in the central nervous system, such as the following:

selective serotonin reuptake inhibitor antidepressants (SSRIs), such as citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine or sertraline
serotonin noradrenaline reuptake inhibitors (SNRIs), such as venlafaxine or duloxetine
the herbal remedy St John's wort (Hypericum perforatum). This medicine is not recommended for use in combination with St John's wort.

References:

https://www.netdoctor.co.uk/medicines/aches-pains/a7183/naramig-naratriptan/

https://www.hpra.ie/img/uploaded/swedocuments/

https://www.medicines.org.uk/emc/product/949/smpc

https://www.patientslikeme.com/treatment/naraverg?brand=t

https://www.mims.ie/monograph/naraverg/?subsection=1467

https://www.ndrugs.com/?s=naraverg

https://www.drugs.com/international/naraverg.html

https://patient.info/medicine/naratriptan-for-migraine-naramig