Contents

Search

sumatriptan (Imitrex, migratriptan, Arcoiran, Sumavel DosePro)

Tradename: Imitrex. Indications: - treatment of migraine with or without aura - may be less effective for migraine with aura [9] Contraindications: 1) ischemic heart disease 2) Prinzmetal's angina 3) uncontrolled hypertension 4) seizures 5) liver or kidney disease 6) concurrent use of ergotamine derivatives 7) concurrent use of MAO inhibitors [5] 8) use for: a) migraine prophylaxis b) hemiplegic migraines c) basilar migraines d) cluster migraines Dosage: 1) sumatriptan succinate: - 6 mg SC, may repeat after 1 hour, max 12 mg/day - do NOT administer IV - 25 mg PO, may repeat up to 100 mg after 2 hours, max 200 mg/day 2) sumatriptan nasal spray - do NOT prime the pump - do not tilt head back or inhale while spraying - 20 mg, 1 spray (10 mg) in each nostril - may repeat in 2 hours if needed - may 40 mg/day Tabs: 25, 50 & 100 mg (sumatriptan succinate). {triangular shape} Injection: 12 mg/mL (0.5 mL syringe, vial) Sumavel DosePro delivers 6 mg of sumatriptan subcutaneously with a high-pressure burst of nitrogen gas instead of a needle [7] Nasal spray: 5 mg, 20 mg. Pharmacokinetics: 1) well absorbed orally 2) time to peak concentration is 5-20 minutes (10-30 minutes) [6] 3) terminal 1/2life is 1.5-2.6 hours 4) 22% eliminated unchanged in the urine Adverse effects: === Nasal === 1) common (> 10%) - bad/unusual taste, nausea/vomiting 2) less common (1-10%) - throat discomfort, nasal cavity/sinus discomfort, dizziness 3) uncommon (< 1%) - atypical or burning sensation === Injection === 1) common (> 10%) - injection site reaction, tingling, hot flashes, dizziness 2) less common (1-10%) - weakness, myalgia, burning sensation, chest tightness, drowsiness, headache, numbness, neck pain & stiffness, abdominal discomfort, mouth discomfort, jaw discomfort, sweating 2) uncommon (< 1%) - thirst, polydipsia, dehydration, dyspnea, hiccups, rash, dysuria, dysmenorrhea, renal calculus 4) other a) coronary vasospasm b) ventricular arrhythmias c) frequent use can exarcerbate migraines [4] d) jet injector (Sumavel DosePro) causes more redness, swelling, bleeding, & bruising than a needle injection [7] Drug interactions: 1) MAO inhibitors: may decrease clearance of sumatriptan; allow 2 weeks after discontinuaton of MAO inhibitor 2) ergot alkaloids: in combination increase level of vasoconstriction 3) selective serotonin reuptake inhibitors (SSRI): in combination may result in weakness, hyper-reflexia & problems with coordination Laboratory: - sumatriptan in blood - sumatriptan in serum/plasma - sumatriptan in urine Mechanism or action: 1) selective agonist of vascular serotonin receptor 1D

Interactions

drug interactions drug adverse effects (more general classes)

Specific

Sumatriptan Topical (Zecuity)

General

amine serotonin agonist (5-HT receptor agonist, triptan) sulfonamide

Properties

SIZE: MW = 295.4 G/M MISC-INFO: elimination route KIDNEY pregnancy-category C safety in lactation ?

Database Correlations

PUBCHEM correlations

References

  1. The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
  2. Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
  3. Kaiser Permanente Northern California Regional Drug Formulary, 1998 (removed 3/2000)
  4. Prescriber's Letter 9(2):2 2002
  5. Prescriber's Letter 10(3):14-15 2003
  6. Features of Available Triptans Prescriber's Letter 11(2):10 2004 Detail-Document#: 200206 (subscription needed) http://www.prescribersletter.com
  7. Prescriber's Letter 17(1): 2010 Comparison of Available Triptans Detail-Document#: 260103 (subscription needed) http://www.prescribersletter.com
  8. Deprecated Reference
  9. Hansen JM et al. Reduced efficacy of sumatriptan in migraine with aura vs without aura. Neurology 2015 May 5; 84:1880 PMID: 25841032 http://www.neurology.org/content/84/18/1880

Component-of

naproxen/sumatriptan (Treximet)