Interactions with supplements
5-Hydroxytryptophan (5-HTP)
Look Up > Drugs > Sumatriptan Succinate
Sumatriptan Succinate
Pronunciation
U.S. Brand Names
Generic Available
Pharmacological Index
Use
Pregnancy Risk Factor
Contraindications
Warnings/Precautions
Adverse Reactions
Drug Interactions
Stability
Mechanism of Action
Pharmacodynamics/Kinetics
Usual Dosage
Mental Health: Effects on Mental Status
Mental Health: Effects on Psychiatric Treatment
Dental Health: Local Anesthetic/Vasoconstrictor Precautions
Dental Health: Effects on Dental Treatment
Patient Information
Nursing Implications
Dosage Forms
References

Pronunciation
(SOO ma trip tan SUKS i nate)

U.S. Brand Names
Imitrex®

Generic Available

No


Pharmacological Index

Serotonin 5-HT1D Receptor Agonist


Use

Acute treatment of migraine with or without aura


Pregnancy Risk Factor

C


Contraindications

Intravenous administration; use in patients with ischemic heart disease or Prinzmetal angina, patients with signs or symptoms of ischemic heart disease, uncontrolled HTN; use with ergotamine derivatives (within 24 hours of); use with in 24 hours of another 5-HT1 agonist; concurrent administration or within 2 weeks of discontinuing an MAOI; hypersensitivity to any component; management of hemiplegic or basilar migraine


Warnings/Precautions

Sumatriptan is indicated only in patient populations with a clear diagnosis of migraine or cluster headache

Cardiac events (coronary artery vasospasm, transient ischemia, myocardial infarction, ventricular tachycardia/fibrillation, cardiac arrest and death) have been reported with 5-HT1 agonist administration. Significant elevation in blood pressure, including hypertensive crisis, has also been reported on rare occasions in patients with and without a history of hypertension. Vasospasm-related reactions have been reported other than coronary artery vasospasm. Peripheral vascular ischemia and colonic ischemia with abdominal pain and bloody diarrhea have occurred.


Adverse Reactions

>10%:

Central nervous system: Dizziness

Endocrine & metabolic: Hot flashes

Local: Injection site reaction

Neuromuscular & skeletal: Paresthesia

1% to 10%:

Cardiovascular: Tightness in chest

Central nervous system: Drowsiness, headache

Dermatologic: Burning sensation

Gastrointestinal: Abdominal discomfort, mouth discomfort

Neuromuscular & skeletal: Myalgia, numbness, weakness, neck pain, jaw discomfort

Miscellaneous: Diaphoresis

<1%: Rashes, polydipsia, dehydration, dysmenorrhea, dysuria, renal calculus, dyspnea, thirst, hiccups


Drug Interactions

Increased toxicity: Ergot-containing drugs, MAOIs, SSRIs can lead to symptoms of hyper-reflexia, weakness, and incoordination


Stability

Store at 2°C to 20°C (36°F to 86°F); protect from light


Mechanism of Action

Selective agonist for serotonin (5-HT1D receptor) in cranial arteries to cause vasoconstriction and reduces sterile inflammation associated with antidromic neuronal transmission correlating with relief of migraine


Pharmacodynamics/Kinetics

Onset of effect: Within 30 minutes

Distribution: Vd: 2.4 L/kg

Protein binding: 14% to 21%

Bioavailability: 15%

Half-life: 2.5 hours

Time to peak serum concentration: 5-20 minutes

Elimination: In urine unchanged (22%), excreted as indole acetic acid metabolite (38%)


Usual Dosage

Adults:

Intranasal: A single dose of 5, 10 or 20 mg administered in one nostril. A 10 mg dose may be achieved by administering a single 5 mg dose in each nostril. If headache returns, the dose maybe be repeated once after 2 hours not to exceed a total daily dose of 40 mg. The safety of treating an average of >4 headaches in a 30-day period has not been established.

S.C.: 6 mg; a second injection may be administered at least 1 hour after the initial dose, but not more than 2 injections in a 24-hour period. If side effects are dose-limiting, lower doses may be used.


Mental Health: Effects on Mental Status

Dizziness is common; may cause drowsiness


Mental Health: Effects on Psychiatric Treatment

Contraindicated with other serotonin agonists (SSRIs) and MAOIs


Dental Health: Local Anesthetic/Vasoconstrictor Precautions

No information available to require special precautions


Dental Health: Effects on Dental Treatment

No effects or complications reported


Patient Information

Take at first sign of migraine attack. This drug is to be used to reduce your migraine, not to prevent or reduce number of attacks. Oral: If headache returns or is not fully resolved after first dose, the dose may be repeated after 2 hours. Do not exceed 300 mg in 24 hours. S.C.: If headache returns or is not fully resolved after first dose, the dose may be repeated after 1 hour. Do not exceed two injections in 24 hours. Do not take within 24 hours of any other migraine medication without first consulting prescriber. You may experience some dizziness (use caution); hot flashes (cool room may help); nausea or vomiting (frequent small meals, frequent mouth care, sucking lozenges, or chewing gum may help); pain at injection site (lasts about 1 hour, will resolve); or excess sweating (will resolve). Report chest tightness or pain; excessive drowsiness; acute abdominal pain; skin rash or burning sensation; muscle weakness, soreness, or numbness; or respiratory difficulty. Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to be pregnant. Consult prescriber if breast-feeding.


Nursing Implications

Pain at injection site lasts <1 hour


Dosage Forms

Injection: 12 mg/mL (0.5 mL, 2 mL)

Spray, Intranasal: 5 mg (100 mL unit dose spray device), 20 mg (100 mL unit dose spray device)

Tablet: 25 mg, 50 mg


References

Akpunonu BE, Mutgi AB, and Federman DJ, "Subcutaneous Sumatriptan for Treatment of Acute Migraine in Patients Admitted to the Emergency Department: A Multicenter Study," Ann Emerg Med, 1995, 25(4):464-9.

Blier P and Bergeron R, "The Safety of Concomitant Use of Sumatriptan and Antidepressant Treatments," J Clin Psychopharmacol, 1995, 15(2):106-9.

Boyd IW and Rohan AP, "Sumatriptan - Induced Chest Pain," Lancet, 1994, 344(8939):1704-5.

Curtin T, Brooks AP, and Roberts JA, "Cardiorespiratory Distress After Sumatriptan Given by Injection," BMJ, 1992, 305(6855):713-4.

Diamond S, "The Use of Sumatriptan in Patients on Monoamine Oxidase Inhibitors," Neurology, 1995, 45(6):1039-40.

Kelly KM, "Cardiac Arrest Following Use of Sumatriptan," Neurology, 1995, 45(6):1211-3.

La Porta LD, "Recurrent Depression After Sumatriptan Administration for Treatment of Migraine," J Clin Psychopharmacol, 1995, 15(1):81-2.

Luman W and Gray RS, "Adverse Reactions Associated With Sumatriptan," Lancet, 1993, 341(8852):1091-2.

MacDonald JT, "Treatment of Juvenile Migraine With Subcutaneous Sumatriptan," Headache, 1994, 34(10):581-2.

Ottervanger JP, van Witsen TB, Valkenburg HA, et al, "Adverse Reactions Attributed to Sumatriptan: A Postmarketing Study in General Practice," Eur J Clin Pharmacol, 1994, 47(4):305-9.

Palmer J, Feldman R, Mancini GB, et al, "Glyceryl Trinitrate Reversal of Post-Sumatriptan Coronary Artery Narrowing," Lancet, 1995, 345(8961):1366.

Scott AK, "Sumatriptan Clinical Pharmacokinetics," Clin Pharmacokinet, 1994, 27(5):337-44.

Srinivas NR, Igwenezue KB, Hainsworth JD, et al, "Lack of Pharmacokinetic Interaction Between Butorphanol Tartrate Nasal Spray and Sumatriptan Succinate," J Clin Pharmacol, 1995, 35(4):432-7.

Srinivas NR, Shyu WC, Upmalis D, et al, "Lack of Pharmacokinetic Interaction Between Butorphanol Tartrate Nasal Spray and Sumatriptan Succinate," J Clin Pharmacol, 1995, 35(4):432-7.

Stricker BH, "Coronary Vasospasm and Sumatriptan," BMJ, 1992, 305(6845):118.

Walton-Shirley M, Flowers K, and Whiteside JH, "Unstable Angina Pectoris Associated With Imitrex Therapy," Cathet Cardiovasc Diagn, 1995, 34(2):188.


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