Sumatriptan nasal prep

Indications

Sumatriptan nasal prep is used for: Acute treatment of migraine with or without aura.

Adult Dose

Acute treatment of migraine attack with or without aura Intranasal spray Preparation 10mg/spray or 20mg/spray The recommended adult dose of Sumatriptan Nasal Spray for the acute treatment of migraine is 10 mg, or 20 mg once daily. The dose is administer as a single nasal spray in 1 nostril. If the migraine has not resolved by 2 hours after taking Sumatriptan Nasal Spray, or returns after a transient improvement, 1 additional dose may be administered at least 1 hour after the first 10 mg single dose or 2 hours after the first 20 mg single dose. If headache returns, may repeat 10 mg single dose once after 1 hr; not to exceed 30 mg/day If headache returns, may repeat 20 mg single dose once after 2 hr; not to exceed 40 mg/day

Child Dose

<18 years: Safety and efficacy not established

Renal Dose

Administration

Contra Indications

Current/history of: ischemic cardiac, cerebrovascular, or peripheral vascular syndromes (angina, MI, stroke, TIA, ischemic bowel disease) Uncontrolled hypertension Coadministration of MAO-A inhibitors or use within 2 weeks after discontinuing MAO-A inhibitors Use within 24 hr of any ergotamine-containing or ergot-type medication (eg, dihydroergotamine or methysergide) Use within 24 hr of other 5-HT1 agonists Hypersensitivity

Precautions

Overuse of acute migraine drugs (eg, ergotamine, triptans, opioids, or combination of these drugs for ≥10 days/month) may lead to exacerbation of headache (medication overuse headache) Serious cardiac and cerebrovascular events, including cerebral hemorrhage, subarachnoid hemorrhage, stroke, acute MI, arrhythmias, and death reported within a few hours after administration Chest discomfort and jaw or neck tightness reported infrequently following intranasal administration (relatively common following SC injection) Not for use with unrecognized CAD as predicted by risk factors (eg, hypertension, hypercholesterolemia, smoking, obesity, diabetes, strong family history of CAD, female with surgical or physiological menopause, male aged >40 yr) Local irritation of nose and throat reported

Pregnancy-Lactation

Pregnancy Category: C Reproductive toxicity studies for sumatriptan by intranasal route have not been conducted; embryolethality and blood vessel abnormalities observed with PO or IV doses in pregnant rabbits during organogenesis Lactation: Excreted in human breast milk in very low levels; minimize infant to potential exposure by avoiding breastfeeding for 8-12 hr after administration

Interactions

Adverse Effects

Side effects of Sumatriptan nasal prep : >10% Bad/unusual taste (13.5-24.5%) Gastrointestinal: nausea/vomiting (11-13.5%) 1-10% Disorder/discomfort of nasal cavity/sinuses (2.5-3.8%) Throat discomfort (0.8-2.4%) Dizziness/vertigo (1-1.7%) Burning sensation (0.4-1.4%) Frequency Not Defined Atypical Sensations: Tingling, numbness, pressure sensation, cold sensation, feeling of tightness Cardiovascular: Flushing, hypertension, palpations, tachycardia, arrhythmia, edema Chest tightness/discomfort, chest pressure/heaviness Disturbance of hearing, ear infections Eye irritation and visual disturbances Gastrointestinal: Abdominal discomfort, diarrhea, dysphagia, GERD, dry mouth, thirst Musculoskeletal: Neck pain/stiffness, backache, weakness, joint symptoms, arthritis, myalgia, muscle cramps Neurological: Drowsiness/sedation, anxiety, sleep disturbances, tremors, syncope, chills, depression, agitation, confusion Respiratory: Dyspnea, lower respiratory infection Skin: Rash/skin eruption, pruritus, erythema Urogenital: Dysuria, dysmenorrhea

Mechanism of Action

Selective 5-HT1 receptor agonist in cranial arteries; elicits vasoconstrictive and anti-inflammatory effects; associated with antidromic neuronal transmission and relief of migraine headache