sumatriptan (Imitrex, migratriptan, Arcoiran, Sumavel DosePro)
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Introduction
Tradename: Imitrex.
Indications
Contraindications
- ischemic heart disease
- Prinzmetal's angina
- uncontrolled hypertension
- seizures
- liver or kidney disease
- concurrent use of ergotamine derivatives
- concurrent use of MAO inhibitors[5]
- use for:
- migraine prophylaxis
- hemiplegic migraines
- basilar migraines
- cluster migraines
Dosage
- sumatriptan succinate:
- sumatriptan nasal spray
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
- well absorbed orally
- time to peak concentration is 5-20 minutes (10-30 minutes)[6]
- terminal 1/2life is 1.5-2.6 hours
- 22% eliminated unchanged in the urine
elimination via kidney
Adverse effects
Nasal
- common (> 10%)
- less common (1-10%)
- throat discomfort, nasal cavity/sinus discomfort, dizziness
- uncommon (< 1%)
Injection
- common (> 10%)
- injection site reaction, tingling, hot flashes, dizziness
- less common (1-10%)
- weakness, myalgia, burning sensation, chest tightness, drowsiness, headache, numbness, neck pain & stiffness, abdominal discomfort, mouth discomfort, jaw discomfort, sweating
- uncommon (< 1%)
- other
- coronary vasospasm
- ventricular arrhythmias
- frequent use can exarcerbate migraines[4]
- jet injector (Sumavel DosePro) causes more redness, swelling, bleeding, & bruising than a needle injection[7]
Drug interactions
- MAO inhibitors: may decrease clearance of sumatriptan; allow 2 weeks after discontinuaton of MAO inhibitor
- ergot alkaloids: in combination increase level of vasoconstriction
- selective serotonin reuptake inhibitors (SSRI): in combination may result in weakness, hyper-reflexia & problems with coordination
- drug interaction(s) anticonvulsants with anti-bacterial agents
- drug interaction(s) of triptans with SNRIs
- drug interaction(s) of triptans with SSRIs
- drug interaction(s) of methylene blue with serotonin agonists
- drug interaction(s) of linezolid with serotonin agonists
- drug interaction(s) of antibiotics with warfarin
Laboratory
- sumatriptan in blood
- sumatriptan in serum/plasma
- sumatriptan in urine Mechanism or action:
- selective agonist of vascular serotonin receptor 1D
More general terms
More specific terms
Component of
References
- ↑ The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- ↑ Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
- ↑ Kaiser Permanente Northern California Regional Drug Formulary, 1998 (removed 3/2000)
- ↑ 4.0 4.1 Prescriber's Letter 9(2):2 2002
- ↑ 5.0 5.1 Prescriber's Letter 10(3):14-15 2003
- ↑ 6.0 6.1 Features of Available Triptans Prescriber's Letter 11(2):10 2004 Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=200206&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 7.0 7.1 7.2 Prescriber's Letter 17(1): 2010 Comparison of Available Triptans Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=260103&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ Deprecated Reference
- ↑ 9.0 9.1 Hansen JM et al. Reduced efficacy of sumatriptan in migraine with aura vs without aura. Neurology 2015 May 5; 84:1880 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25841032 <Internet> http://www.neurology.org/content/84/18/1880