Sumatriptan

DEA Class; Rx

Common Brand Names; Imitrex, Imitrex Statdose, Zembrace SymTouch

• Serotonin 5-HT-Receptor Agonists; 
• Antimigraine Agents

sumatriptan intranasal (Rx)

• Classes: Serotonin 5-HT-Receptor Agonists; 
• Antimigraine Agents

Current/history of ischemic cardiac, cerebrovascular, or peripheral vascular syndromes (angina, MI, stroke, TIA, ischemic bowel disease)

History of stroke, transient ischemic attack, or hemiplegic or basilar migraine

History of coronary artery disease or coronary artery vasospasm

Wolff-Parkinson-White syndrome or other cardiac accessory conduction pathway disorders

Uncontrolled hypertension

DO NOT use IV

Within 2 weeks of MAO-A inhibitors

Within 24 hours of another 5-HT1 receptor agonist or ergot-type medications

Severe hepatic impairment

History of hypersensitivity to drug or components

Uncontrolled hypertension

• Injection site reaction (≤86%)
• Paresthesia (5-14%)
• Dizziness (12%)
• Warm/hot sensation (11%)
• Chest discomfort/pressure/tightness (2-5%)
• Jaw or neck tightness (1-5%)
• Diaphoresis (2%)
• Burning sensation (7%)
• Cold sensation (1%)
• Dysphagia
• Sore throat (3%)
• Malaise (1%)
• Abdominal distress (1%)

Before treating headaches in patients not previously diagnosed with migraine or cluster headache or in patients who present with atypical symptoms, exclude other potentially serious neurological conditions

Equally effective at any stage of migraine, although early use recommended

Overuse of acute migraine drugs (eg, ergotamine, triptans, opioids, or combination of these drugs for ≥10 days/month) may lead to exacerbation of headache (medication overuse headache); detoxification may be necessary

Binds to melanin, may cause toxicity to melanin-rich tissues on prolonged use

Very rare reports of transient and permanent blindness and significant partial vision loss

Serotonin syndrome may occur, particularly during combined use with SSRIs (eg, fluoxetine, paroxetine, sertraline, fluvoxamine, citalopram, escitalopram) or SNRIs (eg, venlafaxine, duloxetine); discontinue therapy if it occurs

Cerebral/subarachnoid hemorrhage and stroke reported with 5-HT1 agonist administration; discontinue if it occurs

Significant elevation of blood pressure, including hypertensive crisis, reported

Not for administration to patients with risk factors for coronary artery disease

Use caution in patients with history of seizure disorder or lowered seizure threshold

May cause depression including dizziness, weakness, or drowsiness (infrequent); caution when operating heavy machinery

Data from a prospective pregnancy exposure registry and epidemiological studies of pregnant women have not detected increased frequency of birth defects or consistent pattern of birth defects among women exposed to sumatriptan compared with general population

Sumatriptan is excreted in human milk following subcutaneous administration; there are no data on effects of sumatriptan on breastfed infant or effects of sumatriptan on milk production

Migraine Headache

Tablet

• 25 mg, 50 mg, or 100 mg PO (taken with fluids)
• Not to exceed 100 mg/dose; additional doses q2hr PRN
• Recommended maximum dose: 200 mg/day
• See also combo with naproxen

Injection

• 6 mg (0.5 mL) SC with autoinjector; may repeat in ≥1 hr
• Not to exceed 12 mg SC q24hr
• Dose may be reduced to 1-5 mg under certain circumstances; eg, adverse reactions

intranasal spray

• 5mg/actuation (Imitrex Intranasal)
• 10mg/actuation (Tosymra)
• 20mg/actuation (Imitrex Intranasal)

intranasal powder (Onzetra Xsail)

• 11mg/capsule in disposable nosepiece