Sumatriptan

Administration

• Type: Ergotamine anti-migraine drug
• Dosage Forms:
• Routes of Administration: Intranasal, oral, subcutanous, transdermal
• Common Trade Names: Imitrex

Adult Dosing

• Intranasal spray: 5-20 mg, may repeat dose if headache persists after 2 hours

Pediatric Dosing

• Intranasal:
  • 5-17 years: 5mg-20mg administered in one nostril as a single dose
• SubQ:
  • 6-71 years: 3-6mg single dose
• Efficacy of oral dosing has not been demonstrated in patients <17 years old.

Special Populations

• Pregnancy Rating: C
• Lactation risk: infant risk minimal
• Renal dosing: no adjustment
• Hepatic dosing: contraindicated in severe hepatic impairment

Contraindications

• Allergy to class/drug
• MAOI use concomitantly or within 2 weeks
• Concomitant use of ergotamine-containing/ergot-type medication within 24 hours
• Use of another 5-HT agonist within 24 hours
• History of cardiovascular (including arrythmias, CAD, uncontrolled hypertension), peripheral vascular, or ischemic bowel disease
• History of stroke/TIA or hemiplegic/basilar migraine
• Severe hepatic impairment

Adverse Reactions

Serious

• MI, hypertensive crisis, ventricular arrhythmias, vasospasm
• Serotonin syndrome
• Stroke, intracranial hemorrhage, seizure
• Visual loss

Common

• Dizziness
• Nausea/vomiting
• URI symptoms

Pharmacology

• Half-life: 2-3 hours
• Metabolism: Hepatic via monamine oxidase (mostly MAO-A)
• Excretion: mostly renal

Mechanism of Action

• Cranial vessel constriction, 5HT agonist, inhibition of pro-inflammatory neuropeptide release

See Also

• Headache
• Serotonin syndrome