Classes
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
Description
Oral serotonin agonist
Used for acute migraine in patients >= 6 years old
Causes less sustained coronary artery constriction than ergot alkaloids
Indications
Indicated for the acute treatment of migraine attacks with or without aura.
Contraindications
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
Adverse Effects
- 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%)
Warnings
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
Pregnancy and Lactation
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
Maximum Dosage
30 mg/day PO per 24 hour period. If also receiving propranolol, do not exceed 15 mg/day PO. The safety of treating > 4 headaches in a 30-day period is not established.
30 mg/day PO per 24 hour period. If also receiving propranolol, do not exceed 15 mg/day PO. The safety of treating > 4 headaches in a 30-day period is not established.
>= 40 kg: 10 mg PO per 24 hour period. If also receiving propranolol, do not exceed 5 mg/day PO.
< 40 kg: 5 mg PO per 24 hour period.
>= 6 years and >= 40 kg: 10 mg PO per 24 hour period. If also receiving propranolol, do not exceed 5 mg/day PO.
>= 6 years and < 40 kg: 5 mg PO per 24 hour period.
< 6 years: Safety and efficacy have not been established.
How supplied
Sumatriptan succinate
tablet
- 25mg
- 50mg
- 100mg
injectable SC solution
- 6mg/0.5mL vial (Imitrex)
prefilled SC syringe/cartridge
- 3mg/0.5mL autoinjector (Zembrace SymTouch)
- 4mg/0.5mL (Imitrex StatDosePen)
- 6mg/0.5mL (Imitrex StatDosePen)
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