BMA Concise Guide to Medicine & Drugs

Sumatriptan

Brand names Imigran, Imigran Radis

Used in the following combined preparations None

QUICK REFERENCE

Drug group Drug for migraine

Overdose danger rating Medium

Dependence rating Low

Prescription needed Yes (injection and nasal spray); No (others)

Available as generic Yes

GENERAL INFORMATION

Sumatriptan is a highly effective drug for migraine, usually given when people fail to respond to analgesics (such as aspirin and paracetamol). The drug is of considerable value in the treatment of acute migraine attacks, whether or not they are preceded by an aura, but is not meant to be taken regularly to prevent attacks. Sumatriptan is also used for the acute treatment of cluster headache (a form of migraine headache). It should be taken as soon as possible after the onset of the attack, although, unlike other drugs used in migraine, it will still be of benefit at whatever stage of the attack it is taken.

INFORMATION FOR USERS

Your drug prescription is tailored for you. Do not alter dosage without checking with your doctor.

How taken/used Tablets, injection, nasal spray.

Frequency and timing of doses Should be taken as soon as possible after the onset of an attack, but it is equally effective at any stage. Do not take a second dose for the same attack, or within 2 hours if migraine recurs.

Adult dosage range Tablets 50–100mg per attack, up to maximum of 300mg in 24 hours if another attack occurs. Do not take a second dose for the same attack, or within 2 hours if migraine recurs. Injection 6mg per attack, up to maximum of 12mg (two injections) in 24 hours if another attack occurs. Do not take a second dose for the same attack, or within 1 hour if migraine recurs. Nasal spray Adults: 1 x 20mg puff into one nostril per attack, to maximum of 40mg (2 puffs) in 24 hours if another attack occurs; Age 12 to 17 years: 1 x 10mg puff into one nostril per attack, to maximum of 20mg (2 puffs) in 24 hours if another attack occurs.

Onset of effect 30–45 minutes (tablets); 10–15 minutes (injection); 15 minutes (nasal spray).

Duration of action Tablets 2–4 hours. Injection 1½–2 hours. Tablets 2–4 hours. Nasal spray 1–3 hours.

Diet advice None, unless otherwise advised.

Storage Keep in original container at room temperature out of the reach of children. Protect from light.

Missed dose Not applicable, as it is taken only to treat a migraine attack.

Stopping the drug Taken only to treat a migraine attack.

Exceeding the dose An occasional unintentional extra tablet or injection is unlikely to cause problems. But if you notice any unusual symptoms, or if a large overdose has been taken, notify your doctor.

POSSIBLE ADVERSE EFFECTS

Many of the adverse effects of sumatriptan disappear after about an hour as your body becomes adjusted to the drug. If the symptoms persist or are severe, contact your doctor. Common adverse effects include pain at the injection site, flushing, a feeling of tingling or heat, and a feeling of heaviness or weakness. Less commonly, the drug may cause dizziness, fatigue, and drowsiness. If you experience palpitations or chest pain, stop taking the drug and seek immediate medical attention.

INTERACTIONS

Antidepressants Monoamine oxidase inhibitors (MAOIs) and some other antidepressants, such as fluvoxamine, fluoxetine, paroxetine, sertraline, and St John’s wort increase the risk of adverse effects with sumatriptan.

Lithium High risk of adverse effects if these drugs are taken together.

Ergotamine must be taken at least 6 hours after sumatriptan, and sumatriptan must be taken at least 24 hours after ergotamine.

SPECIAL PRECAUTIONS

Be sure to consult your doctor or pharmacist before taking this drug if:

· You have liver or kidney problems.

· You have heart problems.

· You have high blood pressure.

· You have had a heart attack.

· You have had a stroke.

· You have angina.

· You are allergic to some medicines.

· You are taking other medicines.

Pregnancy Safety in pregnancy not established. Discuss with your doctor.

Breast-feeding Safety not established. Discuss with your doctor.

Infants and children Not recommended under 12 years.

Over 60 Not recommended for patients over 65 years.

Driving and hazardous work Avoid such activities until you have learned how sumatriptan affects you because the drug can cause drowsiness.

Alcohol No special problems, but some drinks may provoke migraine in some people.

Surgery and general anaesthetics Notify your doctor or dentist if you have used sumatriptan within 48 hours prior to surgery.

PROLONGED USE

Sumatriptan should not be used continuously to prevent migraine but only to treat migraine attacks.