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MyDeficiencies

Almotriptan

Triptan / 5-HT1B,1D agonist

Also sold as Axert, Almogran.

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Findings for this medication

Research about this medication, graded for how strongly each finding can be attributed to it. Nothing here describes your own levels.

Almotriptan carries essentially none of the classical pharmacokinetic machinery that drives drug-induced nutrient depletion. Per its own FDA label, it does not induce or inhibit any CYP450 enzyme, food does not affect its pharmacokinetics, and no mineral or antacid interaction is documented. About 40% of a dose is excreted unchanged in urine by active renal tubular secretion, the remainder is cleared by MAO-A-mediated oxidative deamination and CYP3A4/CYP2D6-mediated hydroxylation to inactive metabolites, with a 3-4 hour half-life. Almotriptan is also taken intermittently, for acute migraine attacks, rather than as a chronic daily medication, which is the dosing pattern behind nearly every well-documented drug-nutrient depletion in the literature (proton-pump inhibitors, diuretics, metformin, anticonvulsants). This sets a low prior plausibility before any nutrient-specific evidence is considered.

Triptan / 5-HT1B,1D agonist · ATC N02CC05 · also sold as Axert and Almogran · reviewed 2026-10-01. This describes research about the medication. It does not say anything about your own levels or health.

How to read the evidence grades

These colours describe how strongly a finding can be attributed to the medication in the research. They are not a severity score and they say nothing about your own health.

Grades describe how strongly a finding can be attributed to Almotriptan in the research — not how common it is, how serious it would be, and not anything about you personally.

Red — Severe
Two or more independent Tier A sources, this drug in the cohort, the nutrient directly measured, consistent direction, clinically meaningful magnitude, a named mechanism, no substantial contradicting Tier A evidence.
Orange — Moderate
At least one Tier A source with this drug in the cohort showing a real but bounded deficit: an exposure window, a subgroup, low frequency, or a functional rather than circulating deficit.
Yellow — Low
Mechanistic plausibility only (Tier B), or class extrapolation (Tier C) with no drug-specific human status data; also used for context flags and interactions running the other direction.
Not graded — disclosed evidence gap
Nothing has been measured here, so this finding cannot be graded. That does not establish either safety or harm, and it is not the same as a White result.Source definition: Not gradeable under the rules above because nothing has been measured. Published as a documented gap, never as reassurance that there is no effect.

What the research found

Magnesium

Yellow — Low

See study details

Migraine patients as a population show lower ionized/serum magnesium than controls in several case-control studies; this is a documented feature of the migraine condition itself, not an effect of almotriptan or any triptan, which has never been studied against this marker.

Full detail and limits

What the grade means here: Mechanistic plausibility only (Tier B), or class extrapolation (Tier C) with no drug-specific human status data; also used for context flags and interactions running the other direction. disease cohort, Tier C

Limits on what this shows

  • Null/negative findings: Thomas et al. (1992) found no significant difference in serum magnesium specifically between migraineurs and controls, a genuine null result on that parameter, even though ionized-magnesium studies elsewhere reported a deficit [6].
  • At-risk subgroups: Migraineurs generally, per the cited literature; not specific to almotriptan users versus untreated migraine patients.

Regulatory status

No magnesium-related finding appears in the almotriptan label.

Population evidence

Thomas, Thomas & Tomb (1992), 79 migraine patients vs. 55 controls, serum and erythrocyte magnesium [6]. Mauskop, Altura, Cracco & Altura (1993), low serum ionized magnesium found in 42% of patients during a migraine attack [7]. Talebi et al. (2011), 140 patients, case-control, serum magnesium vs. attacks [8]. Dolati et al. (2020), narrative review describing migraine as associated with low serum/CSF magnesium [9]. None of these studied almotriptan or any triptan as an exposure; all are migraine-patient-cohort observational studies, not drug trials.

Mechanism

Proposed disease mechanism (cortical spreading depression, NMDA-receptor sensitivity, vascular tone) linked to magnesium status as part of migraine pathophysiology, independent of treatment choice.

Counter-evidence held on record

No study compared magnesium status before versus after starting almotriptan or any triptan. Confounding by indication (the deficit, if real, predates and is independent of treatment choice) is presumed and unexcluded per Hard Rule 6. Must not be presented as "almotriptan depletes magnesium," it does not. This is disease-intrinsic context only, and no magnesium dose is recommended here.

The five body-system areas

Each finding is counted once, in a single area. Where a study is mentioned in a second area it is context only.

Mitochondrial Burden

Each finding below is counted once, in this area only.

Mitochondrial burden

Yellow — Low

See study details

A single supraphysiologic in-vitro study of sumatriptan, a different triptan, found mitochondrial membrane-potential disruption; no almotriptan-specific data exist at any tier.

Full detail and limits

What the grade means here: Mechanistic plausibility only (Tier B), or class extrapolation (Tier C) with no drug-specific human status data; also used for context flags and interactions running the other direction. class extrapolation, Tier C

Limits on what this shows

  • Null/negative findings: No almotriptan in-vitro or in-vivo mitochondrial study was located despite a multi-phrasing search (Step 4). Migraine itself, independent of any drug, has a separate mitochondrial-dysfunction literature (case-control and Mendelian-randomization data); this is disease-intrinsic and must not be attributed to almotriptan treatment.
  • At-risk subgroups: None identified; no human or almotriptan-specific data exist to define one.

Regulatory status

No mitochondrial toxicity signal is listed in the almotriptan FDA label.

Population evidence

None in humans for any triptan. One in-vitro study: isolated rat hepatocytes exposed to sumatriptan at 5 mM (LC50, ~50% membrane lysis at 120 minutes) showed concurrent mitochondrial membrane-potential collapse [5]. 5 mM is far above any plasma concentration achievable from a 6.25-25 mg oral almotriptan or comparable sumatriptan dose.

Mechanism

Proposed cytochrome-P450-mediated reactive-metabolite formation triggering mitochondrial permeability transition at cytotoxic concentrations; the source study found protection by CYP450 inhibitors, supporting a bioactivation-driven toxicity mechanism rather than a direct on-target triptan-receptor effect.

Counter-evidence held on record

The 5 mM concentration used vastly exceeds any achievable human plasma concentration at labeled almotriptan doses; isolated-hepatocyte cytotoxicity assays are a standard high-throughput toxicology screen, not evidence of clinical mitochondrial impairment. This is class-level, supraphysiologic, in-vitro mechanistic evidence for a different triptan (sumatriptan). It should not be read as evidence that almotriptan at labeled doses affects mitochondrial function in migraine patients, and does not support any supplement recommendation.

Oxidative Stress

Each finding below is counted once, in this area only.

Oxidative stress

Yellow — Low

See study details

The same supraphysiologic sumatriptan hepatocyte study found increased reactive-oxygen-species generation, lipid peroxidation, and glutathione depletion; direction appears concentration- and context-dependent and is not established for almotriptan.

Full detail and limits

What the grade means here: Mechanistic plausibility only (Tier B), or class extrapolation (Tier C) with no drug-specific human status data; also used for context flags and interactions running the other direction. class extrapolation, Tier C

Limits on what this shows

  • Null/negative findings: A broader search surfaced titles suggesting other rodent injury-model studies report sumatriptan reducing oxidative markers in different tissues (i.e., a protective direction), but those full texts could not be opened during this review (PMC bot-verification gate; PubMed proxy rate-limiting) and are disclosed here as an access limitation, not cited as confirmed counter-evidence [18, 19].
  • At-risk subgroups: None identified.

Regulatory status

No oxidative-stress-related lab abnormality is listed in the almotriptan label.

Population evidence

Same study as above [5]: ROS generation, lipid peroxidation, and glutathione (GSH) depletion at 5 mM sumatriptan in isolated rat hepatocytes, mitigated by antioxidants (N-acetylcysteine, vitamin E, taurine, quercetin, BHT).

Mechanism

Reactive-oxygen-species generation secondary to CYP-mediated bioactivation at cytotoxic concentrations, as named in the source study.

Counter-evidence held on record

Same supraphysiologic-concentration caveat as Mitochondrial burden above. Apparent directional inconsistency across unopened rodent-model titles (toxic in hepatocytes at 5 mM vs. reportedly protective in other injury models) underscores that this is not a settled depletion signal for the triptan class, let alone for almotriptan. GSH is an endogenously synthesized tripeptide, not a dietary nutrient, and this finding does not support any antioxidant-vitamin supplementation claim tied to almotriptan.

Copper and Iron Balance

Copper and iron are assessed separately. Nothing here is counted twice.

Copper

Not graded — disclosed evidence gap

See study details

No evidence at any tier, for almotriptan or for any triptan, was located linking this drug class to copper status.

Full detail and limits

What the grade means here: Nothing has been measured here, so this finding cannot be graded. That does not establish either safety or harm, and it is not the same as a White result. ungraded

Limits on what this shows

  • Why no grade: Dual condition met: no Tier B/C mechanistic or class-level evidence exists, and no circulating consumer claim exists to rebut as white.

Channels tried

WebSearch: "almotriptan iron OR copper OR hemoglobin OR anemia" (returned only generic copper-deficiency-anemia background, nothing triptan-specific). WebFetch to PubMed search-listing pages for combined almotriptan + mitochondria/oxidative stress/microbiome/copper/iron query, and a dedicated "triptan copper iron microbiome microbiota" query (blocked, HTTP 429, across repeated spaced retries over roughly six minutes). WebFetch to the Europe PMC REST API (blocked, HTTP 403 gateway policy denial) and the Europe PMC web UI (blocked by robots.txt). WebFetch to the Semantic Scholar API and OpenAlex API (both returned HTTP 429 from the target services, not proxy-level blocks). Six general drug-nutrient-depletion consumer references were checked directly (U.S. Pharmacist, Riordan Clinic, McCord Health, Coastal Pharmacy and Wellness, Hayden Institute, Life Extension) and none mention triptans or almotriptan [12-17].

Disclosure

The combination of a genuine multi-phrasing search effort with mid-review rate-limiting and blocking across every scholarly API channel means a true literature gap cannot be fully distinguished from a tooling gap for this specific category at this time. Flagged for re-check in a future revision when full API access is available.

Repair pass, 2026-10-01

A fresh WebFetch query to the PubMed search-listing page for "almotriptan AND (copper OR ceruloplasmin)" completed cleanly and returned a confirmed zero-result page (explicit "No results were found," result count 0), not a block. A Crossref API query combining almotriptan with copper, iron, hemoglobin, and microbiome terms also completed cleanly and returned only generic, unrelated pharmaceutical and biochemistry records, none copper-specific to almotriptan or the triptan class. This session's WebSearch budget was already exhausted (0 of 200 remaining) before this pass began. A cross-check of the six companion triptan dossiers already produced in this project (sumatriptan, rizatriptan, zolmitriptan, naratriptan, frovatriptan, eletriptan) found Copper ungraded in every one, with no class member carrying real supporting data; this strengthens, but does not fully resolve, the case that this is a genuine literature gap rather than a tooling artifact, since Europe PMC, Semantic Scholar, and OpenAlex remained inaccessible or rate-limited throughout.

Iron

Not graded — disclosed evidence gap

See study details

No evidence at any tier, for almotriptan or for any triptan, was located linking this drug class to iron status.

Full detail and limits

What the grade means here: Nothing has been measured here, so this finding cannot be graded. That does not establish either safety or harm, and it is not the same as a White result. ungraded

Limits on what this shows

  • Why no grade: Dual condition met: no Tier B/C mechanistic or class-level evidence exists, and no circulating consumer claim exists to rebut as white.

Channels tried

Same combined search as Copper above (iron was queried jointly with copper, hemoglobin, and anemia in each pass): WebSearch "almotriptan iron OR copper OR hemoglobin OR anemia" (generic background only); WebFetch to PubMed search-listing pages (blocked, HTTP 429, after repeated spaced retries); WebFetch to Europe PMC REST API (HTTP 403 policy denial) and web UI (robots.txt-blocked); WebFetch to Semantic Scholar and OpenAlex APIs (HTTP 429); six consumer drug-nutrient-depletion references checked directly, none mention triptans [12-17].

Disclosure

Same tooling-versus-literature-gap caveat as Copper. Flagged for re-check in a future revision.

Repair pass, 2026-10-01

A fresh WebFetch query to the PubMed search-listing page for "almotriptan AND (iron OR hemoglobin OR hematocrit OR anemia)" completed cleanly and returned a confirmed zero-result page (explicit "No results were found"), not a block. The same Crossref API cross-check described under Copper returned no iron- or hemoglobin-specific almotriptan or triptan-class record. Iron is also ungraded in all six companion triptan dossiers in this project (sumatriptan, rizatriptan, zolmitriptan, naratriptan, frovatriptan, eletriptan); no class member has supporting data to extrapolate from. As with Copper, Europe PMC, Semantic Scholar, and OpenAlex remained inaccessible or rate-limited throughout this pass, so a residual tooling-gap caveat still applies alongside the genuine PubMed and Crossref negatives.

Gut Microbiome Risk

Each finding below is counted once, in this area only.

Gut microbiome risk

Not graded — disclosed evidence gap

See study details

No study tying triptan exposure to gut microbiome composition or diversity was located; almotriptan's labeled nausea/vomiting are also hallmark migraine-attack symptoms independent of treatment.

Full detail and limits

What the grade means here: Nothing has been measured here, so this finding cannot be graded. That does not establish either safety or harm, and it is not the same as a White result. ungraded

Limits on what this shows

  • Why no grade: Dual condition met: no Tier B/C evidence exists, and no circulating claim exists to rebut as white.

Channels tried

WebSearch "triptan serotonin gut microbiome 5-HT1B 1D receptor" (returned general tryptophan/serotonin/gut-brain-axis biology reviews, none naming a specific triptan drug). WebFetch to PubMed search-listing page for "triptan gut microbiome OR intestinal motility" (blocked, HTTP 429, before results could be reviewed). Further WebFetch attempts to Europe PMC and OpenAlex returned the same gateway/rate-limit blocks documented under Copper and Iron above.

Confound noted

Nausea and vomiting are listed adverse effects of almotriptan but are also core diagnostic symptoms of the migraine attack itself; disentangling a drug effect on gut transit/microbiome from the underlying disease would require a study this review could not locate.

Disclosure

Same tooling-versus-literature-gap caveat as Copper and Iron. Flagged for re-check in a future revision.

Repair pass, 2026-10-01

A fresh WebFetch query to the PubMed search-listing page for "almotriptan AND (microbiome OR microbiota OR gut flora)" was blocked mid-attempt (HTTP 429) after the Copper and Iron queries above had already succeeded in the same session, so this category's PubMed check remains incomplete rather than a confirmed clean negative. Two follow-up OpenAlex queries (almotriptan plus gut microbiome/microbiota; triptan serotonin plus gut microbiota and the 5-HT1B/1D receptor) were also blocked (HTTP 429). The Crossref cross-check described under Copper did include microbiome as a search term and returned no almotriptan- or triptan-specific microbiome record, which is a genuine (if partial) negative from one working channel. Gut microbiome risk is ungraded in all six companion triptan dossiers in this project as well, with no class member carrying supporting data. This category's evidence gap is the least completely checked of the three this pass and is the highest-priority re-check once PubMed's microbiome query and Europe PMC/Semantic Scholar/OpenAlex access are unblocked.

Oxygen and ATP Output

Oxygen delivery and ATP production are assessed separately. Nothing here is counted twice.

ATP production

Yellow — Low

See study details

In the same in-vitro study, ATP-generating co-substrates protected against sumatriptan-induced hepatocyte cytotoxicity, suggesting energy-charge involvement in the toxicity mechanism at supraphysiologic concentration; this is not evidence that almotriptan affects ATP production at labeled doses.

Full detail and limits

What the grade means here: Mechanistic plausibility only (Tier B), or class extrapolation (Tier C) with no drug-specific human status data; also used for context flags and interactions running the other direction. class extrapolation, Tier C

Limits on what this shows

  • Null/negative findings: No direct ATP-level measurement study for any triptan was located; no almotriptan data at any tier.
  • At-risk subgroups: None identified.

Regulatory status

No energy-metabolism-related lab abnormality is listed in the almotriptan label.

Population evidence

Same study [5]: L-glutamine and fructose (ATP-generating co-substrates) significantly reduced sumatriptan-induced hepatocyte lysis at 5 mM.

Mechanism

Inferred mitochondrial injury/ATP depletion contributing to the cytotoxicity cascade at cytotoxic concentrations; this is a functional rescue observation (protection by energy substrates), not a direct ATP assay.

Counter-evidence held on record

The rescue-by-energy-substrate finding is indirect evidence of an energy-charge mechanism, not a direct measurement of ATP depletion, and rests on the same 5 mM supraphysiologic exposure as the two entries above. Does not support a CoQ10 or other ATP-support supplementation claim tied to almotriptan.

Oxygen delivery/utilization, drug class's own vasoconstrictive mechanism, class-level muscle-perfusion signal only

Yellow — Low

See study details

A human 31P-MRS study found transient, vasoconstriction-mediated muscle hypoxia and altered oxidative-phosphorylation recovery after subcutaneous sumatriptan, a different triptan; almotriptan was not in that cohort, and this is the triptan class's own intended 5-HT1B/1D vasoconstrictive pharmacology, not a nutrient-mediated oxygen-delivery deficiency (Hard Rule 2).

Full detail, limits and 2 references

What the grade means here: Mechanistic plausibility only (Tier B), or class extrapolation (Tier C) with no drug-specific human status data; also used for context flags and interactions running the other direction. class extrapolation, Tier C · mechanism clarification

Limits on what this shows

  • Null/negative findings: Oxidative-phosphorylation recovery returned to normal during the recovery period in the Boska cohort; the authors described the effect as transient and self-limited, not persistent impairment. No almotriptan-specific muscle-perfusion, oxygenation, hemoglobin, or hematocrit study, positive or negative, was located in this review despite a multi-phrasing, multi-host search (see Sources and access note below).
  • At-risk subgroups: None established for almotriptan specifically; the label's own cardiovascular contraindications define the population where any vasoconstrictive effect, nutrient-related or not, carries real clinical risk.

Regulatory status

The almotriptan FDA label carries class-wide vasospasm-related warnings and cardiovascular contraindications (ischemic/vasospastic coronary artery disease, uncontrolled hypertension, cerebrovascular disease), consistent with 5-HT1B-mediated vasoconstriction as the drug's own intended pharmacology, not a nutrient pathway. No hemoglobin, hematocrit, or oxygen-carrying-capacity abnormality is listed in the label's adverse-reaction or lab data [1].

Population evidence

Boska MD, Welch KMA, Schultz L, Nelson JA, effects of the anti-migraine drug sumatriptan on muscle energy metabolism: relationship to side-effects, Cephalalgia, 2000. Human, n=18 migraine patients, open pre/post design, 6 mg subcutaneous sumatriptan, 31P magnetic resonance spectroscopy of calf muscle during isometric exercise and recovery; PMID 10817445, DOI 10.1046/j.1468-2982.2000.00009.x [20]. Tier B for sumatriptan; Tier C class extrapolation for almotriptan, which was not in the studied cohort.

Mechanism

The study authors attributed the altered oxidative-phosphorylation recovery rate to transient regional muscle hypoxia from vasoconstriction (minor constriction in arteries or capillaries), the triptan class's own vasoactive mechanism, not a mitochondrial, ATP-synthesis, or nutrient-related oxygen-carrying defect. Sumatriptan and almotriptan share the 5-HT1B/1D agonist pharmacophore but clear through different enzyme systems (sumatriptan primarily MAO-A; almotriptan dual MAO-A and CYP3A4/CYP2D6, see Pharmacokinetic basis above), so the class-extrapolation cohort test is met at the receptor-pharmacology level, not the metabolic-pathway level, and mechanistic transfer to almotriptan is correspondingly weaker than a same-pathway class member would provide. Per Hard Rule 2, this entry exists to correctly label that mechanism, not to grade it as a deficiency.

Counter-evidence held on record

This finding is drawn entirely from a subcutaneous-sumatriptan study; almotriptan itself was not in the cohort. Subcutaneous sumatriptan reaches a much faster, higher peak (Tmax about 15 minutes) than oral almotriptan (Tmax 1 to 3 hours per the Pharmacokinetic basis above), making an equivalent transient hemodynamic spike at a comparable magnitude uncertain for almotriptan at labeled oral doses. Graded yellow, not left ungraded, because a real Tier B source exists for a class member and the vasoconstrictive mechanism is class-wide, per the Step 7 yellow-vs-white boundary; this mirrors how companion dossiers for rizatriptan, naratriptan, frovatriptan, zolmitriptan, and sumatriptan itself treat the same or an analogous source (see Overlap map). This is the triptan class's own intended vasoconstrictive pharmacology, not a nutrient-mediated oxygen-delivery deficiency, and does not support any iron, B12, or other oxygen-support supplementation claim tied to almotriptan.

How the body handles this medication

Metabolism
Dual pathway: MAO-A-mediated oxidative deamination (~27% of dose, forms inactive indoleacetic-acid metabolite) and CYP3A4/CYP2D6-mediated pyrrolidine-ring hydroxylation (~12% of dose, forms an inactive GABA derivative); minor flavin monooxygenase-3 N-oxidation and additional minor CYP-mediated N-demethylation.FDA label [1]; liver-enzyme identification study [4]
CYP450 induction/inhibition
Almotriptan does not induce or inhibit any CYP450 enzyme per its own labeling.FDA label [1]
Elimination
~75% renal, ~40% of the oral dose excreted unchanged in urine via active tubular secretion (renal clearance exceeds GFR 3-fold); ~13% fecal.FDA label [1]; DailyMed [2]
Absorption / food-mineral interaction
~70% oral bioavailability, peak plasma 1-3 hours, food does not affect pharmacokinetics; no documented mineral, antacid, or food interaction.FDA label [1]
Renal/hepatic impairment
Severe renal impairment lowers clearance ~65% and raises Cmax ~80%; hepatic impairment lowers clearance up to 60%. Both require a reduced starting dose (6.25 mg, max 12.5 mg/day).FDA label [1]
Documented interactions (magnitude)
Ketoconazole (CYP3A4 inhibitor) +60% exposure; verapamil +20% AUC/+24% Cmax; fluoxetine +18% exposure; moclobemide (MAO inhibitor) -27% clearance/+6% Cmax. All affect almotriptan's own exposure; none run in a nutrient-depleting direction.FDA label [1]; DailyMed [2]
All references used above
  1. AXERT (almotriptan malate) tablets, FDA Highlights/Full Prescribing Information, 2009 revision (s010/s011) — Regulatory label. Tier A.
  2. Almotriptan Malate tablet, film coated, DailyMed label — Regulatory label. Tier A.
  3. Almotriptan, StatPearls, NCBI Bookshelf (NBK541092) — Pharmacology reference. Tier B.
  4. Identification of the Human Liver Enzymes Involved in the Metabolism of the Antimigraine Agent Almotriptan — In-vitro human liver subcellular fraction / cDNA-expressed enzyme study, almotriptan-specific. Tier A/B mechanistic. Complete journal/volume/page/DOI metadata not independently confirmed: the ScienceDirect abstract page did not display full bibliographic detail and a Crossref lookup to confirm it returned HTTP 429 during this review.
  5. Khalili Fard et al., 2016, hepatocyte toxicity induced by sumatriptan and protective effect of antioxidants — In-vitro isolated rat hepatocyte cytotoxicity study, sumatriptan 5 mM. Tier B/C, class extrapolation.Cohort note: sumatriptan, not almotriptan, was studied. Exact journal citation (volume/pages/DOI) could not be independently confirmed; Crossref and PubMed lookups were rate-limited (HTTP 429) during this review.
  6. Thomas J, Thomas E, Tomb E, Serum and erythrocyte magnesium concentrations and migraine, 1992 — 79 migraine patients vs. 55 controls. Tier C, migraine-cohort.Cohort note: no drug exposure studied, migraine patients only. Accessed via PubMed search-listing page; exact PMID not independently confirmed due to rate limiting on the individual article page during this review.
  7. Mauskop A, Altura BT, Cracco RQ, Altura BM, deficiency in serum ionized magnesium in migraine, 1993 — Low serum ionized magnesium found in 42% of patients during a migraine attack. Tier C, migraine-cohort.Cohort note: no drug exposure studied. Same access note as source 6.
  8. Talebi M, et al., relation between serum magnesium level and migraine attacks, 2011 — 140 patients, case-control. Tier C, migraine-cohort.Cohort note: no drug exposure studied. Same access note as source 6.
  9. Dolati S, et al., the role of magnesium in pathophysiology and migraine treatment, 2020 — Narrative review. Tier C, migraine-cohort context.Cohort note: review, not a drug trial. Same access note as source 6.
  10. Bonnefil et al., effect of riboflavin on monoamine oxidase activity in cultured neuroblastoma cells, 1981 — Tier B. Direction is riboflavin status affecting MAO activity, not evidence that MAO-substrate drugs deplete riboflavin. Used only in mechanism-screen reasoning (Step 2D, found absent); not a graded entry.Cohort note: not almotriptan, in-vitro neuroblastoma cell model. PMID not independently confirmed; accessed via PubMed search-listing page during a period of intermittent rate limiting.
  11. WHO Collaborating Centre for Drug Statistics Methodology, ATC/DDD Index, code N02CC05 (almotriptan) — DDD 12.5 mg oral. Tier A, regulatory/standards reference.
  12. U.S. Pharmacist, Drug-Induced Nutrient Depletions: What Pharmacists Need to Know — Checked directly for a circulating almotriptan/triptan claim; none found.
  13. Riordan Clinic, Medication-Induced Nutrient Depletion (PDF) — Checked directly; no triptan/almotriptan mention found.
  14. McCord Health, Drug-Induced Nutrient Depletion: 7 Nutrients Commonly Depleted by Medications — Checked directly; no triptan/almotriptan mention found.
  15. Coastal Pharmacy and Wellness, Drug-Induced Nutrient Depletions: The Warnings Not Listed on Your Rx Label — Checked directly; no triptan/almotriptan mention found.
  16. Hayden Institute, Drug-Induced Nutrient Depletion — Checked directly; no triptan/almotriptan mention found.
  17. Life Extension, Migraine Headache protocol page — Checked directly; discusses triptan mechanism of action and side effects only, no nutrient-depletion claim.
  18. Sumatriptan mitigates bleomycin-induced lung fibrosis in male rats: involvement of inflammation, oxidative stress and α-SMA (PMID 38492426) — Attempted only; not opened and not cited as evidence.Inaccessible: WebFetch to this PubMed record was blocked by proxy rate limiting (HTTP 429) during this review.
  19. Protective effects of sumatriptan against optic nerve injury in rats via modulation of kynurenine pathway, oxidative stress and apoptosis (PMC12008249) — Attempted only; not opened and not cited as evidence.Inaccessible: WebFetch returned a bot-verification/reCAPTCHA gate page instead of article content.
  20. Boska MD, Welch KMA, Schultz L, Nelson JA, effects of the anti-migraine drug sumatriptan on muscle energy metabolism: relationship to side-effects, Cephalalgia, 2000 — Human, n=18 migraine patients, open pre/post design, 6 mg subcutaneous sumatriptan, 31P magnetic resonance spectroscopy of calf muscle during isometric exercise and recovery. Tier A/B for sumatriptan specifically; Tier C class extrapolation for almotriptan. PMID 10817445. DOI 10.1046/j.1468-2982.2000.00009.x. Basis for the Oxygen delivery/utilization entry, added in the 2026-10-01 repair pass.Cohort note: sumatriptan, not almotriptan, was studied. Citation metadata cross-confirmed against this same study as already sourced and cited, with full PMID/DOI, in the companion frovatriptan, rizatriptan, and sumatriptan dossiers in this project; the direct PubMed and Cephalalgia/SAGE Journals record pages were not independently re-fetched in this pass.
  21. PubMed search-listing pages, 2026-10-01 repair pass: "almotriptan AND (copper OR ceruloplasmin)" and "almotriptan AND (iron OR hemoglobin OR hematocrit OR anemia)" — Both queries completed cleanly via WebFetch and both returned confirmed zero-result pages ("No results were found," result count 0), reviewed directly from page content, not inferred. Basis for the strengthened Copper and Iron disclosure above.
  22. PubMed search-listing page, 2026-10-01 repair pass: "almotriptan AND (microbiome OR microbiota OR gut flora)" — Attempted only; not completed.Inaccessible: WebFetch returned HTTP 429 (rate limited) after the two PubMed queries above had already completed successfully in the same pass.
  23. Crossref API (api.crossref.org/works), 2026-10-01 repair pass, query combining almotriptan with copper, iron, hemoglobin, and microbiome terms — Completed cleanly via WebFetch; reviewed results were generic pharmaceutical-reference and unrelated copper/iron/hemoglobin biochemistry and microbiome-science records, none specific to almotriptan or the triptan class. Basis for the Copper, Iron, and Gut microbiome risk repair-pass disclosures above.
  24. OpenAlex API (api.openalex.org/works), 2026-10-01 repair pass, two queries: almotriptan plus gut microbiome/microbiota; triptan serotonin plus gut microbiota and the 5-HT1B/1D receptor — Attempted only; not completed.Inaccessible: both WebFetch attempts returned HTTP 429 (rate limited).
  25. WebSearch tool, 2026-10-01 repair pass, query "almotriptan copper iron deficiency gut microbiome" — Attempted only; not completed.Inaccessible: this session's WebSearch budget was already exhausted (200 of 200 calls used) before this repair pass began; the tool returned that status instead of performing the search.
  26. Companion triptan dossiers, this project, cross-checked 2026-10-01: sumatriptan and rizatriptan (batch B007), zolmitriptan (batch B008), eletriptan, naratriptan, and frovatriptan (batch B009) — Read directly to confirm, by cohort test, whether any triptan class member carries real Tier B/C evidence for Copper, Iron, Gut microbiome risk, or Oxygen delivery/utilization that could be extrapolated to almotriptan. All six leave Copper, Iron, and Gut microbiome risk ungraded; five of the six (all but eletriptan) grade Oxygen delivery/utilization yellow using the Boska et al. 2000 sumatriptan source added to this dossier above, or the related naratriptan-specific PET/catheterization sources.