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Sumatriptan

Medical and Pharmacy Editor:

Brand Name: Imitrex, Imitrex Statdose, Sumavel DosePro, Alsuma, Zembrace SymTouch

Generic Name: sumatriptan

Drug Class: Serotonin 5-HT-Receptor Agonists; Antimigraine Agents

What Is Sumatriptan and How Does It Work?

Sumatriptan is indicated for the acute treatment of migraine, with or without aura, and the acute treatment of cluster headache.

Sumatriptan is available under the following different brand names: Imitrex, Imitrex Statdose, Sumavel DosePro, Alsuma, and Zembrace SymTouch.

Limitations of Use:

  • Use only if a clear diagnosis of migraine or cluster headache has been established. If a patient has no response to the first migraine or cluster headache attack treated with sumatriptan injection, reconsider the diagnosis before sumatriptan injection is administered to treat any subsequent attacks
  • Sumatriptan injection is not indicated for the prevention of migraine or cluster headache attacks

Dosages of Sumatriptan:

Dosage Forms and Strengths

Tablet, immediate-release

  • 25 mg
  • 50 mg
  • 100 mg

Injectable SC solution

  • 6 mg/0.5mL vial (Imitrex)

Prefilled SC syringe/cartridge

  • 3mg/0.5mL autoinjector (Zembrace SymTouch)
  • 4mg/0.5mL (Imitrex StatDosePen)
  • 6mg/0.5mL (Imitrex StatDosePen; Sumavel DosePro; Alsuma Autoinjector)

Dosage Considerations – Should be Given as Follows:

Migraine Headache

Tablet

  • 25 mg, 50 mg, or 100 mg orally (taken with fluids)
  • Not to exceed 100 mg/dose; additional doses every 2 hours as needed
  • Recommended maximum dose: 200 mg/day
  • See also combo with naproxen

Injection

  • 6 mg (0.5 mL) subcutaneously (SC) with autoinjector; may repeat in 1 hour or more
  • Not to exceed 12 mg SC every 24 hours
  • Dose may be reduced to 1-5 mg under certain circumstances; e.g., adverse reactions

Cluster Headache

  • 6 mg (0.5 mL) subcutaneously (SC) with autoinjector; may repeat in 1 hour or more
  • Not to exceed 12 mg SC every 24 hours
  • Dosing considerations
    • Dose may be reduced under certain circumstances; e.g., adverse reactions

Dosage Modifications

  • Mild to moderate hepatic impairment: Oral not to exceed 50 mg/dose; no dosage adjustments necessary if administered subcutaneously (SC) (use with caution)
  • Severe hepatic impairment: Contraindicated
  • Children under 18 years: Safety and efficacy not established
  • Geriatric use not recommended (higher incidence of adverse effects)

What Are Side Effects Associated with Using Sumatriptan?

Side effects associated with use of Sumatriptan, include the following:

Other side effects of sumatriptan include:

This document does not contain all possible side effects and others may occur. Check with your physician for additional information about side effects.

What Other Drugs Interact with Sumatriptan?

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider or pharmacist first.

Severe Interactions of Sumatriptan Include:

  • almotriptan
  • bromocriptine
  • cabergoline
  • dihydroergotamine
  • dihydroergotamine intranasal
  • eletriptan
  • ergoloid mesylates
  • ergonovine
  • ergotamine
  • frovatriptan
  • methylergonovine
  • naratriptan
  • procarbazine
  • rizatriptan
  • zolmitriptan

Serious Interactions of sumatriptan include:

Mild Interactions of sumatriptan include:

This information does not contain all possible interactions or adverse effects. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share this information with your doctor and pharmacist. Check with your health care professional or doctor for additional medical advice, or if you have health questions, concerns or for more information about this medicine.

What Are Warnings and Precautions for Sumatriptan?

Warnings

  • This medication contains sumatriptan
  • Do not take Imitrex, Imitrex Statdose, Sumavel DosePro, Alsuma, or Zembrace SymTouch if you are allergic to sumatriptan or any ingredients contained in this drug
  • Keep out of reach of children
  • In case of overdose, get medical help or contact a Poison Control Center immediately

Contraindications

Effects of Drug Abuse

No information provided

Short-Term Effects

  • May cause central nervous system (CNS) depression including dizziness, weakness, or drowsiness (infrequent); caution when operating heavy machinery
  • See "What Are Side Effects Associated with Using Sumatriptan?"

Long-Term Effects

  • Overuse of acute migraine drugs (e.g., ergotamine, triptans, opioids, or combination of these drugs for 10 days/month or more) 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
  • See "What Are Side Effects Associated with Using Sumatriptan?”

Cautions

  • Use when clear diagnosis of migraine established
  • Equally effective at any stage of migraine, although early use recommended
  • Overuse of acute migraine drugs (e.g., ergotamine, triptans, opioids, or combination of these drugs for 10 days/month or more) 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 (e.g., fluoxetine, paroxetine, sertraline, fluvoxamine, citalopram, escitalopram) or SNRIs (e.g., 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 central nervous system (CNS) depression including dizziness, weakness, or drowsiness (infrequent); caution when operating heavy machinery
  • Coronary artery vasospasm, transient ischemia, ventricular tachycardia/fibrillation, myocardial infarction, cardiac arrest and death reported with use 5HT1 agonists; perform cardiac evaluation in patients with multiple cardiovascular risk factors; evaluate for coronary artery disease in patients at high risk; discontinue therapy if arrhythmia occurs
  • Use oral formulations with caution in patients with mild-to-moderate hepatic impairment if treatment necessary and advisable; presystemic clearance, when administered orally, is reduced in hepatic impairment and cause an increase in plasma concentrations; dose reduction recommended; when administered parenterally (SC, intranasal), does not undergo first pass metabolism and may not cause increase in plasma concentrations

Pregnancy and Lactation

  • Use sumatriptan with caution during pregnancy if benefits outweigh risks. Animal studies show risk and human studies are not available, or neither animal nor human studies were done
  • Embryolethality and blood vessel abnormalities observed with oral or intravenous (IV) doses in pregnant rabbits during organogenesis
  • Sumatriptan is excreted in breast milk at very low levels (NLM TOXNET); minimize infant to potential exposure by avoiding breastfeeding for 8-12 hours after administration
Reviewed on 4/11/2017


SOURCE:
Medscape. Sumatriptan.
https://reference.medscape.com/drug/imitrex-sumavel-dosepro-sumatriptan-343034
References:
DailyMed. Sumatriptan.
https://dailymed.nlm.nih.gov/dailymed/
drugInfo.cfm?setid=efdeaab6-e8a0-4858-8bc4-4f4a6b55730d

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