pronounced as (soo ma trip' tan)
Sumatriptan is used to treat the symptoms of migraine headaches (severe, throbbing headaches that sometimes are accompanied by nausea or sensitivity to sound and light). Sumatriptan is in a class of medications called selective serotonin receptor agonists. It works by narrowing blood vessels in the head, stopping pain signals from being sent to the brain, and blocking the release of certain natural substances that cause pain, nausea, and other symptoms of migraine. Sumatriptan does not prevent migraine attacks or reduce the number of headaches you have.
Sumatriptan comes as a tablet to take by mouth. It is usually taken at the first sign of a migraine headache.If your symptoms improve after you take sumatriptan but return after 2 hours or longer, you may take a second tablet. However, if your symptoms do not improve after you take sumitriptan, do not take a second tablet without calling your doctor. Your doctor will tell you the maximum number of tablets you may take in a 24-hour period.Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take sumatriptan exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
You may take your first dose of sumatriptan in a doctor's office or other medical facility where you can be monitored for serious reactions.
Call your doctor if your headaches do not get better or occur more frequently after taking sumatriptan.
If you take sumatriptan more often or for longer than the recommended period of time, your headaches may get worse or may occur more frequently. You should not take sumatriptan or any other headache medication for more than 10 days per month. Call your doctor if you need to take sumatriptan to treat more than four headaches in a 1-month period.
Ask your pharmacist or doctor for a copy of the manufacturer's information for the patient.
This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.
Before taking sumatriptan,
- tell your doctor and pharmacist if you are allergic to sumatriptan, any other medications, or any of the ingredients in sumatriptan tablets. Ask your pharmacist for a list of the ingredients.
- do not take sumatriptan if you have taken any of the following medications in the past 24 hours: other selective serotonin receptor agonists such as almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), or zolmitriptan (Zomig); or ergot-type medications such as bromocriptine (Parlodel), cabergoline, dihydroergotamine (D.H.E. 45, Migranal), ergoloid mesylates (Hydergine), ergonovine (Ergotrate), ergotamine (Cafergot, Ergomar, Wigraine), methylergonovine (Methergine), methysergide (Sansert), and pergolide (Permax).
- do not take sumatriptan if you are taking a monoamine oxidase A (MAO-A) inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), or tranylcypromine (Parnate) or if you have taken one of these medications in the past 2 weeks.
- tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: acetaminophen (Tylenol); antidepressants such as amitriptyline (Elavil), amoxapine (Asendin), clomipramine (Anafranil), desipramine (Norpramin), doxepin (Adapin, Sinequan), imipramine (Tofranil), nortriptyline (Aventyl, Pamelor), protriptyline (Vivactil), and trimipramine (Surmontil); aspirin and other nonsteroidal anti-inflammatory medications (NSAIDs) such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn); selective serotonin reuptake inhibitors (SSRIs) such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem, in Symbyax), fluvoxamine, paroxetine (Paxil), and sertraline (Zoloft); and selective serotonin/norepinephrine reuptake inhibitors (SNRIs) such as desvenlafaxine (Pristiq), duloxetine (Cymbalta), sibutramine (Meridia), and venlafaxine (Effexor). Your doctor may need to change the doses of your medications or monitor you more carefully for side effects.
- tell your doctor if you have or have ever had heart disease; a heart attack; angina (chest pain); irregular heartbeats; stroke or 'mini-stroke'; or circulation problems such as varicose veins, blood clots in the legs, Raynaud's disease (problems with blood flow to the fingers, toes, ears, and nose), or ischemic bowel disease (bloody diarrhea and stomach pain caused by decreased blood flow to the intestines). Your doctor may tell you not to take sumatriptan.
- tell your doctor if you smoke or are overweight; if you have or have ever had high blood pressure, high cholesterol, diabetes, seizures, or liver or kidney disease; if you have gone through menopause (change of life); or if any family members have or have ever had heart disease or stroke.
- tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you plan to be sexually active while you are using this medication, talk to your doctor about effective methods of birth control. If you become pregnant while taking sumatriptan, call your doctor.
- you should know that this medication may make you drowsy or dizzy. Do not drive a car or operate machinery until you know how this medication affects you.
Unless your doctor tells you otherwise, continue your normal diet.
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature, away from excess heat and moisture (not in the bathroom).
Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.
It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org
In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.
Keep all appointments with your doctor. Your blood pressure should be checked regularly.
You should keep a headache diary by writing down when you have headaches and when you take sumatriptan.
Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.
It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.
- Treximet® (containing Naproxen, Sumatriptan)
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Imitrex side effects
Imitrex can cause mild or serious side effects. The following lists contain some of the key side effects that may occur while taking Imitrex. These lists don’t include all possible side effects.
For more information on the possible side effects of Imitrex, talk with your doctor or pharmacist. They can give you tips on how to deal with any side effects that may be bothersome.
Note: The Food and Drug Administration (FDA) tracks side effects of drugs it has approved. If you would like to report to the FDA a side effect you’ve had with Imitrex, you can do so through MedWatch.
Mild side effects
Mild side effects of Imitrex can include:*
- feeling weak
- feeling unusually warm or cold
- tingling or numbness in your fingers or toes
- irritation in your nose or throat, such as burning, tingling, pain, or numbness (with the nasal spray)
- unpleasant taste in your mouth (with the nasal spray)
- injection site reactions, such as pain, stinging, redness, or swelling (with the injection)
- pain, pressure, or tightness in your chest, throat, neck, or jaw†
Most of these side effects go away within a few hours or days. But if they become more severe or don’t go away, talk with your doctor or pharmacist.
* This is a partial list of mild side effects from Imitrex. To learn about other mild side effects, talk with your doctor or pharmacist, or see the patient information for the form of Imitrex you’re taking: Imitrex tablets, Imitrex nasal spray, or Imitrex injection (with either a syringe or injection pen).
† For more information on these side effects, see “Side effect details” below.
Serious side effects
Serious side effects from Imitrex aren’t common, but they can occur. Call your doctor right away if you have serious side effects. Call 911 or your local emergency phone number if your symptoms feel life threatening or if you think you’re having a medical emergency.
Serious side effects and their symptoms can include:
- Serious heart problems, such as heart attack. Symptoms can include:
- severe pain, pressure, or tightness in your chest, arm, throat, neck, or jaw
- Irregular heartbeat. Symptoms can include:
- feeling that your heart is pounding, racing, or skipping a beat
- Stroke or bleeding in the brain. Symptoms may vary but can include:
- drooping on one side of the face
- sudden weakness or numbness on one side of the body
- slurred speech or trouble speaking
- Problems with blood circulation, such as Raynaud’s disease (lack of blood flow to your nose, ears, fingers, or toes). Symptoms may vary but can include:
- white, blue, or purple fingers and toes
- cramping or pain in your legs
- weakness, tingling, or numbness in your legs
- Reduced blood flow to your stomach or intestines. Symptoms can include:
- sudden or severe belly pain
- Serotonin syndrome (a dangerous condition caused by high levels of serotonin in your body). Symptoms can include:
- feeling agitated or restless
- Very high blood pressure. Symptoms can include:
- Seizures. Symptoms can include:
- sudden, rapid eye movements
- loss of bowel or bladder control
- loss of consciousness (not being able to respond to sound or touch)
- Allergic reaction.*
- Medication overuse headache,* also called a rebound headache.
* For more information on these side effects, see “Side effect details” below.
Side effect details
You may wonder how often certain side effects occur with this drug. Here’s some detail on several of the side effects this drug may cause.
As with most drugs, some people can have an allergic reaction after taking Imitrex. It’s not known how often this occurs. Symptoms of a mild allergic reaction can include:
- skin rash
- flushing (warmth and redness in your skin)
A more severe allergic reaction is rare but possible. Symptoms of a severe allergic reaction can include:
- swelling under your skin, typically in your eyelids, lips, hands, or feet
- swelling of your tongue, mouth, or throat
- trouble breathing
Call your doctor right away if you have a severe allergic reaction to Imitrex. Call 911 or your local emergency phone number if your symptoms feel life threatening or if you think you’re having a medical emergency.
Taking Imitrex can make some people feel sleepy. In clinical studies:
- 3% of people who took Imitrex injection felt sleepy
- 2% of people who took a placebo (a treatment with no active drug) felt sleepy
It’s not known how often sleepiness occurs with the Imitrex tablets or nasal spray.
Along with sleepiness, Imitrex can also cause weakness and dizziness in some people. These side effects, as well as the migraine or cluster headache itself, can make it dangerous to drive or operate machinery. If you have these side effects, avoid driving and using machinery until you feel recovered enough to do so safely.
If you’re concerned about feeling sleepy while taking Imitrex, talk with your doctor.
Injection side effects
The most common side effects associated with the Imitrex injection are reactions at the injection site.
In clinical studies:
- 59% of people who used the Imitrex injection had a reaction at their injection site
- 24% of people who used a placebo (a treatment containing no active drug) had a reaction at their injection site
Injection site reactions may include pain, stinging, burning, swelling, redness, bruising, or bleeding where you have the injection. If you have pain, stinging, burning, or bleeding, this should only last for a short time after you have the injection. Bruising or swelling is usually mild and should go away in a few days.
If you have an injection site reaction that makes your skin especially sore or swollen, or lasts longer than a few days, see your doctor.
You should rotate your injection site each time you use the Imitrex injection. This will help avoid making any injection site reactions worse.
Other than injection site reactions, side effects with the Imitrex injection are similar to side effects with other forms of Imitrex.
Weight loss isn’t a direct side effect of Imitrex. However, it can be a symptom of reduced blood flow to your stomach or intestines, which is a serious side effect of Imitrex. It’s not known how often this side effect occurs with Imitrex.
Besides weight loss, other symptoms of reduced blood flow to your stomach or intestine can include:
- sudden or severe belly pain
- bloody diarrhea
- nausea and vomiting
See your doctor right away if you have unexplained weight loss or any of these other symptoms after taking Imitrex.
Taking medication to treat headaches too often can lead to medication overuse headache, also called rebound headache. This occurs when you have migraine attacks or cluster headaches every day, or more often than usual.
Taking pain relievers of any kind on 10 or more days per month can lead to medication overuse headache. And taking too much Imitrex, or taking it too often, can also cause this problem.
You shouldn’t take more than the recommended dosage of Imitrex. (See the “Imitrex dosage” section below to learn more.) And keep in mind that it’s not known if it’s safe to take Imitrex to treat more than four headaches in any 30-day period.
It’s a good idea to keep a headache diary to make sure you’re not making your headaches worse by taking medication too often. Record when you have migraine or cluster headaches, how you treat them, and if the treatment worked.
If your migraine or cluster headaches get worse, or happen more often than usual, talk with your doctor about ways to prevent them. Also talk with your doctor if you’re using Imitrex to treat more than four headaches a month.
Pain in the chest, jaw, or neck
You may feel pain, pressure, tightness, or heaviness in your chest, neck, or jaw after taking a dose of Imitrex. These sensations can feel intense, but they typically improve quickly.
In clinical studies:
- up to 3% of people who took Imitrex tablets had these sensations
- 2% to 7% of people who received Imitrex injections had these sensations
- up to 2% of people who took a placebo (a treatment containing no active drug) had these sensations
It’s not known how often these sensations occurred in people who used the Imitrex nasal spray.
Talk with your doctor if you have pain, pressure, tightness, or heaviness in your chest, neck, or jaw after taking Imitrex. They can suggest ways to help you feel better, such as lowering your dosage or switching medications.
On rare occasions, these sensations could be symptoms of heart problems, such as a heart attack. It’s not known how often pain, pressure, tightness, or heaviness in the chest, neck, or jaw were symptoms of a heart attack in people taking Imitrex.
Call 911 or your local emergency phone number if you experience:
- pain, pressure, tightness, or heaviness in your chest, arm, neck, or jaw that’s severe or doesn’t go away in a few minutes
- trouble breathing
- cold sweat
Nausea is a common symptom of migraine. Some people find that taking Imitrex helps reduce the nausea that they have with their migraine, as well relieving the headache. But some people may have nausea as a side effect of taking Imitrex.
In clinical studies, people who used the Imitrex nasal spray had slightly more nausea than those who used a placebo (a treatment containing no active drug). This could be because the Imitrex nasal spray can cause an unpleasant taste in your mouth.
In these studies:
- 11% to 13.5% of people who used Imitrex nasal spray experienced nausea and vomiting
- 11.3% of people who used a placebo experienced nausea and vomiting
If you have nausea with Imitrex, talk with your doctor. They may be able to suggest ways to relieve this side effect.
Sumatriptan is a medicine to treat migraines and cluster headaches. It does not prevent these conditions.
It belongs to a group of medicines called triptans, or serotonin (5-HT1) agonists.
You take sumatriptan once a migraine or cluster headache has started. It is not a painkiller but you can use this medicine if painkillers or non-steroidal anti-inflammatory drugs (NSAIDs) have not worked.
Sumatriptan comes as tablets, a nasal spray or injection. The nasal spray and injection are used to treat migraines and cluster headaches. The tablets are used for migraines only.
Sumatriptan tablets, nasal spray and injections are available on prescription. You can also buy packs containing two 50mg tablets from a pharmacy without a prescription, but only if you have previously been diagnosed with migraines.
2. Key facts
- Take sumatriptan as soon as a migraine or cluster headache starts.
- The tablets usually work within 30 to 60 minutes. The spray and injection work quicker.
- Common side effects include feeling or being sick, feeling sleepy or dizzy.
- Do not take migraine medicines such as ergotamine or other triptans when taking sumatriptan.
- Sumatriptan is also known by the brand names Imigran, Migraitan and Boots Migraine Relief 50mg Tablets.
3. Who can and cannot take sumatriptan
Most adults with migraines can have sumatriptan tablets or injections. But the nasal spray is only officially approved for people under the age of 65.
Sumatriptan is not officially approved for children. However, a specialist doctor may sometimes prescribe it for a child over the age of 6 years.
Sumatriptan is not suitable for some people. To make sure it's safe for you, tell your doctor if you:
- have had an allergic reaction to sumatriptan or any other medicine in the past
- have a heart problem such as coronary heart disease, chest pain (angina), heart rhythm problems (arrhythmia) or you've had a heart attack
- have circulation problems in your legs (peripheral vascular disease)
- have had a stroke or "mini stroke" (transient ischaemic attack)
- have liver disease or other liver problems
- have seizures or fits
- are trying to get pregnant, are already pregnant or breastfeeding
- are a heavy smoker or use nicotine replacement therapy (particularly if you've been through menopause, or if you're a man over the age of 40)
- have high blood pressure
You may be able to use sumatriptan if you've had high blood pressure in the past and it is now well controlled with treatment.
If you have a latex allergy, check with your doctor or a pharmacist before having sumatriptan injections. Some needle protectors may contain latex.
4. How and when to take it
Always follow your doctor's instructions when taking this medicine.
Take your first dose as soon as the pain starts.
Do not take it at the warning stage, before your migraine starts. This is when some people get symptoms of "aura".
Tablets (for migraine only)
Swallow the tablet whole with a drink of water. Do not chew or crush it.
If you find tablets difficult to swallow, some come with a line in the middle to help you break them in half. Check the information leaflet inside the medicine packet to see if you can do this with your medicine.
The usual dose is 50mg. But some people may be prescribed 100mg.
The tablets should work in 30 to 60 minutes. If your migraine improves but then comes back, you can take the same dose again after 2 hours.
However, if the first dose of sumatriptan does not help, do not take another dose for the same attack.
Injections (migraine or cluster headache)
Read the instructions that come with your medicine to find out how to use the pre-filled syringe (auto-injector) and how to get rid of it safely afterwards.
Use the pre-filled syringe to inject 1 dose. This contains 6mg of sumatriptan. You'll usually inject it into your thigh.
The medicine generally works in 10 to 15 minutes.
If your headache improves but then comes back, you can inject another dose after 1 hour.
However, if the first sumatriptan injection does not help, do not have another one for the same attack.
Nasal spray (migraine or cluster headache)
Read the instructions that come with your medicine to find out how to use the single-use nasal spray. Each spray contains 1 dose (10mg or 20mg of sumatriptan).
- Blow your nose if it feels blocked or if you have a cold.
- Place your finger over 1 nostril.
- Spray the medicine into the other nostril and breathe in gently at the same time.
The nasal spray usually works within 15 minutes.
If your headache improves but then comes back, you can have another dose after 2 hours.
However if the first dose of sumatriptan does not help, do not take another dose for the same attack.
Do not have more than 2 injections, or 2 doses of nasal spray, or more than 300mg of tablets in 24 hours.
What if I take too much?
Do not take more than the prescribed amount in any 24-hour period. The maximum amount is 300mg of tablets, 12mg as injections or 40mg as a nasal spray.
Taking too much sumatriptan may make you very ill. An overdose can cause fainting, slowed heart rate, vomiting, loss of bladder and bowel control, and sleepiness.
It can narrow your blood vessels leading to heart problems such as chest pains, abnormal heart rhythm or a heart attack. It can also reduce the blood supply to other organs such as part of your large intestine This can give you a severe stomach ache.
Urgent advice: Contact 111 for advice now if:
- you take too much sumatriptan
Go to 111.nhs.uk or call 111
If you need to go to hospital, do not drive yourself. Get someone else to drive you or call for an ambulance.
Take the sumatriptan packet or leaflet inside it plus any remaining medicine with you.
7. Pregnancy and breastfeeding
Sumatriptan is not thought to be harmful during pregnancy, but there is not enough research to say for certain.
Talk to a doctor about the benefits and possible harms of taking sumatriptan. There may be other medicines that are safer for you.
Find out more about how sumatriptan can affect you and your baby during pregnancy by Best Use of Medicines in Pregnancy (BUMPS).
Sumatriptan and breastfeeding
It's usually safe to take sumatriptan if you're breastfeeding. Only small amounts of the medicine get into breast milk and so it's not enough to cause any problems for your baby.
However, speak to a doctor if your baby was premature or has any health problems.
Tell a doctor if you're trying to get pregnant, you are already pregnant or if you're breastfeeding.
8. Cautions with other medicines
There are some medicines that may interfere with the way sumatriptan works.
Tell your doctor before you take sumatriptan if you're already taking:
- other migraine or headache medicines (including ergotamine and other triptans)
- antidepressants called MAOIs (monoamine oxidase inhibitors
If you're taking antidepressants, check with your doctor whether it's safe to take sumatriptan with your other medicines. Using sumatriptan with some types of antidepressants can increase your risk of a severe side effect called serotonin syndrome.
Symptoms of seretonin sydrome include:
- feeling confused or agitated
- muscle twitching
- high temperature, sweating or shivering
- increased heart rate
Tell a doctor immediately if you get any of these symptoms.
Mixing sumatriptan with herbal remedies or supplements
Taking sumatriptan with St John's wort (hypericum perforatum) can increase your risk of serotonin syndrome. Do not take St John's wort if you're using sumatriptan.
9. Common questions
Is sumatriptan a habit-forming narcotic?
If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
Migraine headaches can put a damper on your life. They’re not just regular old headaches. They can be debilitating, and for some, migraine attacks can mean you lock yourself away in a dark room, missing work, life, and any normal social interactions. Even on days when you pull up your socks and power through, it can be hard to function when you feel nauseous, dizzy, or weak (Friedman, 2016). On days like these, some people find that certain prescription medications can really help.
- Sumatriptan is not a narcotic. Sumatriptan is a triptan, which is a class of medications typically used to treat migraines. Narcotics, on the other hand, are opioid pain relievers that can be habit-forming.
- Sumatriptan specifically relieves migraine pain, but not other types of pain like menstrual cramps or a sprained ankle.
- Sumatriptan works best when used early, at the first signs of migraine headache pain. It’s not suitable to use as a preventative medication.
Sumatriptan is one of the most commonly prescribed medications for migraines and cluster headaches, and research shows that it’s effective (Smith, 2020). If you’re taking sumatriptan for the first time, you may have questions about its safety and whether it’s addictive. Sumatriptan isn’t a habit-forming narcotic, but it is possible to overuse migraine medications.
One result is a medication overuse headache (MOH) or “rebound headache” (Diener, 20014). Another, more serious result could be serotonin syndrome, which can be fatal if untreated (Heller, 2018). Read on to learn how sumatriptan works and how to use it safely.
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The short answer is no. Sumatriptan (brand name Imitrex) is a triptan, one of a group of drugs that includes almotriptan, zolmitriptan, frovatriptan, rizatriptan, naratriptan, eletriptan, and of course, sumatriptan (Smith, 2020). Narcotics are another group of drugs entirely, called opioids. Opioids are pain relievers like codeine, fentanyl, oxycodone, tramadol, and morphine and can be habit-forming (Vorvick, 2019). While sumatriptan is used to alleviate the pain of migraine headaches, it’s not a general pain reliever. It won’t alleviate the pain of a sprained ankle, for example, or menstrual cramps, and it won’t get you “high.”
Doctors may prescribe narcotics to relieve migraines, but only if other treatments haven’t worked. Narcotics can be addictive, and they are often not more effective than aspirin in relieving migraines. Healthcare providers will normally try other treatment options first and prescribe narcotics only when other treatments fail (Worthington, 2013).
And while sumatriptan is not a narcotic, it’s still possible to take too much. Taking too much sumatriptan or other migraine medication can lead to medication overuse headache (MOH), or “rebound headache” (Diener, 2014).
A medication overuse headache (MOH) is a headache caused by using too much medication—specifically pain medication. Interestingly, it’s not something that happens to people who use pain relievers for other conditions like arthritis—it’s specific to people who have a headache disorder (Kristofferson, 2014). You’ll know you have it if you have had a headache for at least 15 days a month for three months running and if your headaches get worse while using migraine medication (AMF, 2016).
The last thing you want from your migraine medication is another headache. The Imitrex label advises limiting using migraine medications to 10 times a month (FDA, 2013). This includes sumatriptan (or other triptans), ergotamines (like Cafergot, Ergomar, Wigraine), dihydroergotamine (like Migrenal), and other ergot-type drugs, or opioids (like codeine or oxycodone) or any combination of these (NIH, 2015). You can also get MOH from overuse of over the counter pain relievers like acetaminophen (Friedman, 2016).
While medication overuse headaches are certainly something you want to avoid, there’s an even more pressing reason not to overuse migraine medications: serotonin syndrome.
Serotonin is a naturally occurring chemical in our bodies. It passes signals from our brain cells and between the brain and the rest of our body. Sumatriptan and many other drugs work by acting like serotonin or affecting our body’s serotonin levels. Taking too many of any one of these medications or combining them can cause serotonin syndrome, which can be fatal if not treated (Heller, 2018).
Signs of serotonin syndrome include high blood pressure, a fast heartbeat, sweating, fever, and diarrhea. Other symptoms include muscle spasms, tremors or shivering, abnormal eye movements, and lack of coordination. Serotonin syndrome also can make you feel anxious, disoriented or confused, restless, or even cause hallucinations (Heller, 2018). These symptoms will usually occur within minutes or hours of taking sumatriptan or starting a newly increased dosage (FDA, 2013). If you experience any of these symptoms, stop taking sumatriptan immediately, and seek emergency medical attention.
To avoid serotonin syndrome, do not take more than your prescribed dose of sumatriptan. Also, speak to your healthcare provider to receive instruction on how much to take if you are taking any of the following medications, which are often prescribed for depression or Parkinson’s disease:
Sumatriptan (brand name Imitrex) is one of the most commonly prescribed migraine medications, and research shows that it works (Derry, 2014). However, researchers are still not exactly sure how migraines and migraine medications work. But we do know a few important things.
We know a migraine headache happens when a trigger turns “on” pain signals. Triggers differ from person to person but commonly reported triggers include stress, lack of sleep, hormonal changes (like getting your period), or even food, alcohol, or certain smells (Friedman, 2016).
We also know that sumatriptan is migraine-specific (Smith, 2020). It stops a migraine headache in action and prevents it from getting worse (Ahn, 2005). That’s why it works best when used as early as possible—as soon as the pain begins. Unfortunately, it doesn’t work to prevent migraine attacks from happening and can’t be used to prevent them (Worthington, 2013).
Now you know only to take sumatriptan (brand name Imitrex) after your migraine starts and that it is possible to take too much. So how much should you take? Imitrex is a prescription medication and should be taken according to the instructions provided by your healthcare provider or pharmacist.
Sumatriptan dosage depends on how you take it. It is available as a tablet, nasal spray, or injection. It’s also available in a tablet that combines sumatriptan with the pain reliever naproxen (brand name Treximet). Here are a few basics on each format.
Oral sumatriptan tablets:
- Available in 25 mg, 50 mg, or 100 mg doses.
- 100 mg doses work best, but 50 mg doses can balance effectiveness with reduced side effects.
- The maximum dose in a 24 hour period is 200 mg.
- Problematic for patients who become nauseous and vomit, especially early in the migraine (Smith, 2020).
Sumatriptan (brand name Imitrex) can leave you feeling tired or drowsy, so don’t drive or do anything that requires you to be alert (FDA, 2013). Other side effects of the drug depend on how you take it.
People who take the oral sumatriptan tablet may experience an upset stomach or diarrhea, cramps, hot and cold flashes, or a tingling sensation. You might also feel tired, drowsy, or heavy (NIH, 2015)
The most common side effect reported by people who take nasal sumatriptan is that it leaves an unpleasant taste in their mouth (Smith, 2020). Other common side effects are a sore throat, irritation, or a tingling sensation in the nose, nausea, flushing, or an irregular or pounding heartbeat (NIH, 2019).
Patients who use sumatriptan self-injections can have a reaction at the injection site, including redness or irritation or a tingling or warm feeling. Other side effects include muscle cramps, nausea, and vomiting (NIH, 2017).
Some side effects of sumatriptan can be more serious. Symptoms such as tightness in the throat, neck, jaw, or chest, a pounding heartbeat, shortness of breath, and chest pains are all potentially serious side effects of sumatriptan (NIH, 2015). These signs can also be symptoms of something else entirely, such as a heart attack (FDA, 2013). If you experience any of these side effects, especially if you have ever had heart problems or if you are at risk for a heart attack, it is important to be evaluated by a healthcare professional.s
A healthcare provider may choose a different medication for you if you have any conditions or take any medications that could make sumatriptan potentially harmful to you. Here are some of the risk factors.
Heart disease or vascular conditions: Sumatriptan works by constricting blood vessels, which means it could be harmful to people who have heart disease or other blood vessel (vascular) conditions. These include coronary artery disease (CAD), a previous heart attack, transient ischemic attacks (TIA), Prinzmetal angina, hypertension, vasospasms, ischemic bowel disease, or a history of strokes or uncontrolled high blood pressure, among other conditions (FDA, 2013).
Sumatriptan can also cause arrhythmias (irregular heartbeats) (FDA, 2013). Let your healthcare provider know if you’ve experienced this condition in the past. There may be alternative treatments that can better help alleviate your migraines.
Drug interactions: Sumatriptan cannot be combined with ergot-containing medications. These medications, which include drugs like Cafergot, Ergomar, or Wigraineare also frequently prescribed for the treatment of migraines. Since both these and triptan drugs like sumatriptan constrict blood vessels, combining them can result in serious side effects and even death.
Current guidelines recommend waiting at least 24 hours between taking an ergot medication and taking a triptan. Also, do not combine different triptan medications. (NIH, 2015). Tell your healthcare provider about any other medications you are taking. Sumatriptan can be very dangerous if combined with other medications, including some drugs used to treat anxiety and depression as well as drugs used to treat Parkinson’s disease (FDA, 2013).
Liver disease:People with liver disease may need a lower dose (FDA, 2013).
Let your healthcare provider know if:
- You have had an allergic reaction to sumatriptan or any ingredient in the medication
- You have a history of seizure or any other condition that makes you prone to seizure
- You have a history of stroke or transient ischemic attack (TIA)
If you’re worried about whether your migraine medication is safe, speak to your healthcare provider. Understanding how your medication works and the risk factors will mean you’ll be armed with the knowledge to help you use your migraine drugs safely and effectively.
- Ahn, A. H., & Basbaum, A. I. (2005). Where do triptans act in the treatment of migraine? Pain, 115(1), 1–4. https://doi.org/10.1016/j.pain.2005.03.008 Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1850935/
- Derry, C. J. (2014, May 24). Sumatriptan (all routes of administration) for acute migraine attacks in adults ‐ overview of Cochrane reviews. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009108.pub2/full
- Diener, H.-C., & Limmroth, V. (2004). Medication-overuse headache: a worldwide problem. The Lancet Neurology, 3(8), 475–483. https://doi.org/10.1016/s1474-4422(04)00824-5 Retrieved September 11, 2020 from https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(04)00824-5/fulltext
- Friedman, D. I. (2016). Your Loved One Has Migraines. Headache: The Journal of Head and Face Pain, 56(8), 1368-1369. doi:10.1111/head.12880 Retrieved September 11, 2020 from: https://headachejournal.onlinelibrary.wiley.com/doi/abs/10.1111/head.12880
- GlaxoSmithKline. (2013, November). Imitrex Tablets Sumatriptan succinate, FDA Approved Label. Retrieved September 3, 2020, from https://www.accessdata.fda.gov/drugsatfda_docs/label/2013/020132s028,020626s025lbl.pdf
- Heller, J. L. (2018, April). Serotonin syndrome: MedlinePlus Medical Encyclopedia. MedlinePlus. Retrieved from https://medlineplus.gov/ency/article/007272.htm
- Kristoffersen, E. S., & Lundqvist, C. (2014). Medication-overuse headache: epidemiology, diagnosis and treatment. Therapeutic Advances in Drug Safety, 5(2), 87–99. https://doi.org/10.1177/2042098614522683 Retrieved 11 September, 2020 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4110872/#bibr46-2042098614522683
- Law, S., Derry, S., & Moore, R. A. (2010). Sumatriptan plus naproxen for acute migraine headaches in adults. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.cd008541, Retrieved 11 September, 2020 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4176624/
- National Institutes of Health. (2015, November). Sumatriptan: MedlinePlus Drug Information. MedlinePlus. Retrieved September 3, 2020, from https://medlineplus.gov/druginfo/meds/a601116.html
- National Institues of Health. (2017, December). Sumatriptan Injection: MedlinePlus Drug Information. MedlinePlus. Retrieved September 3, 2020, from https://medlineplus.gov/druginfo/meds/a696023.html
- National Institutes of Health. (2019, September). Sumatriptan Nasal: MedlinePlus Drug Information. MedlinePlus. Retrieved September 3, 2020, from https://medlineplus.gov/druginfo/meds/a614029.html
- Negro, A., Koverech, A., & Martelletti, P. (2018). Serotonin receptor agonists in the acute treatment of migraine: a review on their therapeutic potential. Journal of Pain Research, Volume 11, 515–526. Retrieved from https://doi.org/10.2147/jpr.s132833
- Perry, C. M., & Markham, A. (1998). Sumatriptan. Drugs, 55(6), 889–922. https://doi.org/10.2165/00003495-199855060-00020
- Rothrock, J. F. (2010). Injectable Sumatriptan: Now Needle-Based or Needle-Free: AMF. Retrieved 10 September, 2020, from https://americanmigrainefoundation.org/resource-library/injectable-sumatriptan-now-needle-based-needle-free/
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Sumatriptan controlled is
Sumatriptan nasal spray in adolescent migraineurs: a randomized, double-blind, placebo-controlled, acute study
Objective: To compare the efficacy and tolerability of sumatriptan nasal spray (NS) (5, 20 mg) versus placebo in the acute treatment of migraine in adolescent subjects.
Background: Currently, no triptan is approved in the United States for the treatment of migraine in adolescent subjects (12 to 17 years). In a previous randomized, placebo-controlled study of 510 adolescent subjects, sumatriptan NS at 5, 10, and 20 mg doses was well tolerated. However, the primary efficacy analysis for headache relief with 20 mg at 2 hours did not demonstrate statistical significance (P = .059). A second study was initiated to evaluate the efficacy of sumatriptan NS in this population.
Methods: This was a randomized (1:1:1), placebo-controlled, double-blind, parallel-group study. Overall, 738 adolescent subjects (mean age: 14 years) with > or = 6-month history of migraine (with or without aura) self-treated a single attack of moderate or severe migraine. The primary endpoints were headache relief at 1 hour and sustained relief from 1 to 24 hours. Pain-free rates, presence/absence of associated symptoms, headache recurrence, and use of rescue medications were also assessed. Tolerability was based on adverse events (AEs) and vital signs.
Results: Sumatriptan NS 20 mg provided greater headache relief than placebo at 30 minutes (42% vs. 33%, respectively; P = .046) and 2 hours (68% vs. 58%; P = .025) postdose, but did not reach statistical significance at 1 hour (61% vs. 52%; P = .087) or for sustained headache relief from 1 to 24 hours (P = .061). Significant differences (P < .05) in favor of sumatriptan NS 20 mg over placebo were observed for several secondary efficacy endpoints including sustained relief from 2 to 24 hours. In general, sumatriptan NS 5 mg percentages were slightly higher than placebo but the differences did not reach statistical significance. Both doses of sumatriptan NS were well tolerated. No AEs were serious or led to study withdrawal. The most common event was taste disturbance (2%, placebo; 19%, sumatriptan NS 5 mg; 25%, sumatriptan NS 20 mg).
Conclusions: This study suggests that sumatriptan may be beneficial to some adolescents and is generally well tolerated in the acute treatment of migraine in this population.
Placebo-controlled comparison of effervescent acetylsalicylic acid, sumatriptan and ibuprofen in the treatment of migraine attacks
Acetylsalicylic acid (ASA) in combination with metoclopramide has been frequently used in clinical trials in the acute treatment of migraine attacks. Recently the efficacy of a new high buffered formulation of 1000 mg effervescent ASA without metoclopramide compared to placebo has been shown. To further confirm the efficacy of this new formulation in comparison with a triptan and a nonsteroidal anti-inflammatory drug (ibuprofen) a three-fold crossover, double-blind, randomized trial with 312 patients was conducted in Germany, Italy and Spain. Effervescent ASA (1000 mg) was compared to encapsulated sumatriptan (50 mg), ibuprofen (400 mg) and placebo. The percentage of patients with reduction in headache severity from moderate or severe to mild or no pain (primary endpoint) was 52.5% for ASA, 60.2% for ibuprofen, 55.8% for sumatriptan and 30.6% for placebo. All active treatments were superior to placebo (P < 0.0001), whereas active treatments were not statistically different. The number of patients who were pain-free at 2 h was 27.1%, 33.2%, 37.1% and 12.6% for those treated with ASA, ibuprofen, sumatriptan or placebo, respectively. The difference between ASA and sumatriptan was statistically significant (P = 0.025). With respect to other secondary efficacy criteria and accompanying symptoms no statistically significant differences between ASA and ibuprofen or sumatriptan were found. Drug-related adverse events were reported in 4.1%, 5.7%, 6.6% and 4.5% of patients treated with ASA, ibuprofen sumatriptan or placebo. This study showed that 1000 mg effervescent ASA is as effective as 50 mg sumatriptan and 400 mg ibuprofen in the treatment of migraine attacks regarding headache relief from moderate/severe to mild/no pain at 2 h. Regarding pain-free at 2 h sumatriptan was most effective.
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