Sumatriptan

1. Introduction

Sumatriptan is a selective serotonin (5-HT1B/1D) receptor agonist used for the acute treatment of migraines and cluster headaches. It works by constricting cranial blood vessels and inhibiting inflammatory neuropeptides, helping to relieve headache pain and associated symptoms such as nausea and sensitivity to light or sound.

2. Indications

  • Acute Migraine Attack (With or Without Aura): In adults and some adolescents.
  • Cluster Headaches: Fast-acting relief for episodic cluster headaches.

3. Dosage

Adults:

  • Migraine (Oral):
    • 50 mg once at migraine onset.
    • If no relief after 2 hours, a second dose may be taken (maximum: 200 mg/day).
  • Migraine (Subcutaneous Injection):
    • 6 mg subcutaneously; if needed, a second dose may be given after 1 hour (maximum: 12 mg/day).
  • Migraine (Nasal Spray):
    • 10–20 mg in one nostril; repeat after 2 hours if needed (maximum: 40 mg/day).
  • Cluster Headache (Subcutaneous Injection):
    • 6 mg subcutaneously once, may repeat after 1 hour if needed (maximum: 12 mg/day).

Elderly (>65 years):

  • Use with caution; cardiovascular assessment may be needed.

Children & Adolescents (12–17 years, Migraine Only):

  • Oral: 50 mg once; maximum 100 mg/day.
  • Nasal Spray: 10 mg in one nostril; repeat after 2 hours if needed.

Patients with Hepatic Impairment:

  • Maximum oral dose: 50 mg/day.
  • Subcutaneous and nasal formulations should be avoided.

Patients with Renal Impairment:

  • No dose adjustments needed, but use with caution.

4. Administration

  • Take at the first sign of a migraine for best results.
  • Do not use for migraine prevention—only for acute attacks.
  • Oral tablets should be swallowed whole with water.
  • Subcutaneous injections should be given in the thigh or upper arm.
  • Nasal spray should be administered in one nostril; avoid sniffing immediately after use.

5. Forms Available

  • Tablets: 50 mg, 100 mg
  • Subcutaneous Injection: 6 mg/0.5 mL
  • Nasal Spray: 10 mg, 20 mg

6. Side Effects

6.1 Common Side Effects:

  • Tingling or warmth sensation
  • Dizziness
  • Flushing
  • Injection site reaction (if using subcutaneous form)
  • Nausea

6.2 Less Common Side Effects:

  • Chest tightness (non-cardiac)
  • Fatigue
  • Dry mouth

6.3 Rare but Serious Side Effects:

  • Serotonin Syndrome (agitation, confusion, sweating, tremors)
  • Heart Attack (Myocardial Infarction)
  • Stroke or Transient Ischaemic Attack (TIA)
  • Severe Hypertension

7. Warnings

  • Cardiovascular Risk: Contraindicated in patients with coronary artery disease, history of stroke, or uncontrolled hypertension.
  • Serotonin Syndrome: Risk increases when combined with SSRIs, SNRIs, or other triptans.
  • Medication Overuse Headache (Rebound Headache): Avoid excessive use (>10 days/month).
  • Hypertension Risk: Can cause transient increases in blood pressure.

8. Precautions

  • Avoid in patients with significant cardiovascular risk factors (e.g., smoking, diabetes, hyperlipidaemia).
  • Do not use in patients with basilar migraine or hemiplegic migraine, as safety is not established.
  • Avoid within 24 hours of using another triptan or ergot derivative (e.g., ergotamine).

9. Interactions

  • SSRIs/SNRIs (e.g., fluoxetine, venlafaxine): Increased risk of serotonin syndrome.
  • Ergot Alkaloids (e.g., ergotamine, dihydroergotamine): Avoid within 24 hours due to excessive vasoconstriction.
  • MAOIs (e.g., phenelzine): Contraindicated within 2 weeks of MAOI use.
  • Beta-blockers (e.g., propranolol): May enhance triptan effects.

10. Monitoring Parameters

  • Blood Pressure: Especially in hypertensive patients.
  • Cardiovascular Assessment: Required in high-risk individuals before prescribing.
  • Frequency of Use: To prevent medication overuse headaches.

11. Use in Children

  • Approved for use in adolescents (12–17 years) for migraines using nasal spray or 50 mg oral tablet.
  • Not recommended in children under 12 years due to insufficient data.

12. Use in Pregnancy

  • Category C: Use only if the benefits outweigh the risks. Limited human data suggest no major birth defects, but caution is advised.

13. Use in Elderly

  • Not commonly recommended due to increased cardiovascular risk.
  • If used, cardiovascular evaluation is advised before initiation.

14. Use in Kidney Disease

  • No dose adjustments required.
  • Monitor for adverse effects due to reduced clearance.

15. Use in Liver Disease

  • Max oral dose: 50 mg/day.
  • Avoid nasal and subcutaneous formulations.

16. Patient Counselling Points

  • Take sumatriptan as soon as migraine symptoms begin for best results.
  • Do not use more than two doses in 24 hours.
  • Avoid using sumatriptan for more than 10 days per month to prevent medication overuse headaches.
  • If chest pain, severe dizziness, or confusion occurs, seek medical help immediately.
  • Avoid driving if dizziness or drowsiness occurs.

17. Table of Brand Names, Manufacturer, and Prices in USD

Brand NameManufacturerStrength/Dosage FormPrice (USD)
ImitrexGlaxoSmithKline50 mg Tablet$50 (1 tablet)
Imitrex InjectionGlaxoSmithKline6 mg/0.5 mL$100 (1 dose)
Generic SumatriptanVarious50 mg Tablet$10 (1 tablet)

18. 15 FAQs (Frequently Asked Questions)

1. What is Sumatriptan used for?
Sumatriptan is used for the acute treatment of migraines and cluster headaches.

2. How does Sumatriptan work?
It constricts cranial blood vessels and blocks pain pathways in the brain.

3. How quickly does Sumatriptan work?

  • Tablets: 30–60 minutes.
  • Nasal spray: 10–15 minutes.
  • Injection: 5–10 minutes.

4. Can Sumatriptan be taken daily?
No, it should only be used as needed and not more than 10 days per month.

5. Can Sumatriptan prevent migraines?
No, it is only for acute migraine treatment, not prevention.

6. Can I take a second dose if the first dose doesn’t work?
Yes, if there is no relief after 2 hours, a second dose can be taken.

7. Can Sumatriptan cause chest pain?
Yes, chest tightness is a common side effect but severe chest pain requires immediate medical attention.

8. Can Sumatriptan be used in pregnancy?
Use only if benefits outweigh risks.

9. Can Sumatriptan be used with ibuprofen or paracetamol?
Yes, it can be taken with NSAIDs or paracetamol for additional pain relief.

10. Does Sumatriptan interact with antidepressants?
Yes, it can increase the risk of serotonin syndrome when combined with SSRIs or SNRIs.

11. How many times can I use Sumatriptan in a month?
Ideally, no more than 10 days per month to avoid rebound headaches.

12. Can I drive after taking Sumatriptan?
Avoid driving if you experience dizziness or drowsiness.

13. Can Sumatriptan cause high blood pressure?
Yes, it may cause a transient increase in blood pressure.

14. How should Sumatriptan be stored?
Store at room temperature, away from moisture.

15. Can Sumatriptan be taken with caffeine?
Yes, but avoid excessive caffeine intake.