Sumatriptan

Indications

Sumatriptan is used for: Migraine, Cluster headache

Adult Dose

Oral Migraine Adult: >18 yr: 50-100 mg repeated at 2-hr intervals if migraine recurs. Max: 200 mg/24 hr. Mild to moderate hepatic impairment: Max single dose: 50 mg. Severe hepatic impairment: Contraindicated

Child Dose

<18 years: Safety and efficacy not established

Renal Dose

Administration

May be taken with or without food.

Contra Indications

Not to be used prophylactically and in patients with basilar or hemiplegic or ophthalmoplegic migraine. History of MI or stroke, severe hepatic impairment, ischaemic heart disease, uncontrolled hypertension, peripheral vascular disease, hypersensitivity to sulfonamides.

Precautions

Conditions predisposing to seizures, presence of coronary risk factors, cardiac arrhythmias, renal or hepatic impairment, elderly, pregnancy, lactation. Lactation: Excreted in breast milk at very low levels; minimize infant to potential exposure by avoiding breastfeeding for 8-12 hours after administration

Pregnancy-Lactation

Pregnancy 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; in developmental toxicity studies in rats and rabbits, oral administration of sumatriptan to pregnant animals was associated with embryolethality, fetal abnormalities, and pup mortality; when administered by intravenous route to pregnant rabbits, sumatriptan was embryolethal However, possible disease-associated maternal and/or embryo/fetal risk reported; several studies have suggested that women with migraine may be at increased risk of preeclampsia during pregnancy Lactation 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; developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for injection and any potential adverse effects on breastfed infant from sumatriptan or from underlying maternal condition Infant exposure to sumatriptan can be minimized by avoiding breastfeeding for 12 hr after therapy

Interactions

Concurrent use increased risk of vasospastic reaction with ergotamine and related compounds. Potentially Fatal: Increased risk of serotonin syndrome with concurrent use of SSRI, MAOIs or within 14 days of stopping MAOIs. Admin of ergotamine or related compounds within the previous 24 hr.

Adverse Effects

Side effects of Sumatriptan : >10% Injection site reaction (<86%), Paresthesia (5-14%), Dizziness (12%), Warm/hot sensation (11%) 1-10% 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%) Frequency Not Defined Agitation, Cardiac arrhythmia: V-fib/V-tach (rare), Dysuria, Eye irritation, Flushing, MI and coronary artery vasospasm in patients with CAD risk factors (extremely rare), Nasal discomfort, Palpitations, Tingling, Weakness Potentially Fatal: Cardiac arrhythmias, MI.

Mechanism of Action

Sumatriptan is a selective serotonin agonist that acts at 5-HT1 receptors. It causes vasoconstriction of cranial arteries and/or inhibition of neurogenic inflammatory processes in the CNS. A small but significant delay in gastric emptying also occurs.