"Today, the U.S. Food and Drug Administration approved Topamax (topiramate) for prevention (prophylaxis) of migraine headaches in adolescents ages 12 to 17. This is the first FDA approval of a drug for migraine prevention in this age group. The me"...
The following adverse reactions are discussed in more detail in other sections of the prescribing information:
- Allergic Contact Dermatitis [see WARNINGS AND PRECAUTIONS]
- Myocardial ischemia, myocardial infarction, and Prinzmetal's angina [see WARNINGS AND PRECAUTIONS]
- Arrhythmias [see WARNINGS AND PRECAUTIONS]
- Chest, throat, neck, and/or jaw pain/tightness/pressure [see WARNINGS AND PRECAUTIONS]
- Cerebrovascular events [see WARNINGS AND PRECAUTIONS]
- Other vasospasm reactions [see WARNINGS AND PRECAUTIONS]
- Medication overuse headache [see WARNINGS AND PRECAUTIONS]
- Serotonin syndrome [see WARNINGS AND PRECAUTIONS]
- Increase in blood pressure [see WARNINGS AND PRECAUTIONS]
- Anaphylactic/anaphylactoid reactions [see WARNINGS AND PRECAUTIONS]
Clinical Trials Experience
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared with rates in the clinical trials of another drug and may not reflect the rates observed in practice.
In two long-term, open-label studies in which patients were allowed to treat multiple migraine attacks for up to 1 year, 15% (99 out of 662) withdrew from the study because of adverse reaction. The most common adverse reactions leading to withdrawal from the study were contact dermatitis (4%) and application site pain (4%).
Controlled single dose acute migraine study
Table 1 lists adverse reactions that occurred at a frequency of 2% or greater in a controlled clinical study of ZECUITY in patients with acute migraine (Study 1) [see Clinical Studies]. In that study, patients randomized to the control group used the same activated iontophoretic transdermal delivery system (TDS) as patients randomized to ZECUITY, with the only difference being the absence of sumatriptan in the drug reservoir. Therefore, patients in the control group were exposed to same TDS-related risks as patients in the ZECUITY group, minus the risks related to sumatriptan. Only reactions that occurred at a frequency of 2% or more in patients treated with ZECUITY or control are included in Table 1.
Table 1: Adverse Reactions Reported by at least 2% of
Patients in Study 1
|Adverse Reaction||Percent of Subjects Reporting|
(n = 234)
(n = 235)
|Application site pain||26%||17%|
|Application site paresthesia||9%||16%|
|Application site pruritus||8%||7%|
|Application site warmth||6%||3%|
|Application site discomfort||6%||6%|
|Application site irritation||4%||2%|
|Application site discoloration||3%||1%|
The incidence of “atypical sensations” adverse events (paresthesia, sensation warm/cold) and “pain and other pressure sensations” (chest pain/tightness/pressure/heaviness or neck/throat/jaw pain, tightness, pressure or heaviness) was 2% each in ZECUITY-treated patients, vs. 0% in the control group.
Application site bruising was reported in 2 ZECUITY-treated patients (0.9%) vs. no patient in the control group.
Subgroup analyses of age ( ≤ 41 years, > 41 years), race (Caucasian, non-Caucasian) and body mass index (BMI) ( ≤ 25.7 mg/kg2, > 25.7 mg/kg2) showed no difference between subgroups for adverse events.
Skin Irritation Examination
In Study 1, patients performed their own examination of the TDS application site at 4, 12, and 24 hours post TDS activation, and daily thereafter until resolution. Skin irritation examination scores are summarized in Table 2. The median time to “no redness” was 2.6 days for Zecuitycompared with 0.3 day in the control group.
Table 2: Subject Self-examination Skin Irritation
(n = 234)
(n = 235)
|4 hours||No or minimal redness||39%||73%|
|Intense redness with blisters/broken skin||2%||2%|
|12 hours||No or minimal redness||69%||90%|
|Intense redness with blisters/broken skin||2%||1%|
|24 hours||No or minimal redness||79%||93%|
|Intense redness with blisters/broken skin||1%||1%|
Application site reactions across clinical studies (Controlled single dose acute migraine study and long term safety studies)
In the controlled and uncontrolled clinical studies combined (n = 796 unique ZECUITY-treated subjects), the frequency of application site reactions of clinical interest is presented in Table 3.
Table 3: Application Site Reactions
|Event||Percent of Subjects Reporting
(N = 796)
Read the Zecuity (sumatriptan iontophoretic transdermal system) Side Effects Center for a complete guide to possible side effects
Ergot-containing drugs have been reported to cause prolonged vasospastic reactions. Because these effects may be additive, use of ergotamine-containing or ergot-type medications (like dihydroergotamine or methysergide) and ZECUITY within 24 hours of each other is contraindicated [see CONTRAINDICATIONS].
Monoamine Oxidase-A Inhibitors
Other 5-HT1 Agonists
Because their vasospastic effects may be additive, coadministration of ZECUITY and other 5-HT1 agonists (e.g., triptans) within 24 hours of each other is contraindicated.
Selective Serotonin Reuptake Inhibitors/Serotonin Norepinephrine Reuptake Inhibitors And Serotonin Syndrome
Cases of serotonin syndrome have been reported during coadministration of triptans and SSRIs or SNRIs, SNRIs, TCAs, and MAO inhibitors [see WARNINGS AND PRECAUTIONS].This monograph has been modified to include the generic and brand name in many instances.
Last reviewed on RxList: 4/3/2014
Additional Zecuity Information
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