Sumatriptan, Imitrex/Onzetra/Sumavel/Tosymra/Zembrace is a selective agonist for serotonin 5-HT1B and 5-HT1D receptors. These are located on intracranial blood vessels and sensory nerves of the trigeminal system and activating these receptors causes vasoconstriction and reduces neurogenic inflammation associated with antidromic neuronal transmission. These actions are thought to be the cause of migraine relief.
Indications For Use
Sumatriptan, Imitrex/Onzetra/Sumavel/Tosymra/Zembrace is officially indicated to treat moderate to severe acute migraines and to treat acute cluster headaches depending on the dosage form. It is also prescribed off-label for abortive therapy of migraine associated cyclic vomiting syndrome.
Before starting Sumatriptan, Imitrex/Onzetra/Sumavel/Tosymra/Zembrace make sure your physician is aware of any allergies or medications you currently take (MAO inhibitors/ergotamine derivatives), if you have any cardiovascular disease, cerebrovascular disease, liver disease, a history of hemiplegic migraine, ophthalmoplegic migraine, a seizure disorder, are pregnant, or breastfeeding. This medication has risk of causing serotonin syndrome especially if combined with other serotonergic drugs. Before triptans are used a full cardiac workup including ECG may be considered.
Oral 25-100 mg per dose, can repeat dose in 2 hours or later if only partial relief or if symptoms return to a maximum of 200mg/24 hours.
Nasal 10mg can be repeated in 1 hour or later if only partial relief or if symptoms return to a maximum of 30mg in 24 hours.
Inject 6mg subcutaneously, can be repeated in 1 hour or later if only partial relief or if symptoms return to a maximum of 12mg in 24 hours. If 6mg was not tolerated, the second dose can be 1-5mg.
Pharmacist Tips On Using
How to Take Sumatriptan, Imitrex/Onzetra/Sumavel/Tosymra/Zembrace: Follow instructions provided by physician/pharmacy label, use at first sign of migraine symptoms, store at room temperature.
You Need to Avoid: Do not use triptans more than 10 times per month to avoid medication overuse headache.
Injection: Tingling sensation, dizziness, vertigo, flush, injection site reaction
Tablet: Pain, sensation of pressure in head, tingling sensation, chest pain
Note this is not a complete list of side effects, only common ones
Frequently Asked Questions
What is a medication overuse headache? Using medication to treat headaches regularly over a long period of time can start resulting in causing a rebound headache. Regular pain reliever use in people without a headache disorder does not result in this phenomenon. Medication overuse headaches usually stop after pain medication is discontinued for a while which can be very difficult in the short term, but once completed result in long term relief. Medication overuse headaches may differ depending on the original type of headache treated and the medication used, but they tend to occur every day, or nearly every day often waking one in the early morning and improve with use of pain medication but come back as soon as it wears off. It is important to not overuse your pain medication and follow your physician’s instructions even if it means you have to tolerate headaches symptoms a few times a month to prevent this from occurring.
What is serotonin syndrome? Serotonin syndrome is a rare, but potentially life-threatening condition of serotonin toxicity from too much of it in your system generally from the use of certain medications and supplements. Usually multiple agents are at play or high doses are involved. The signs and symptoms include agitation, hallucinations, delirium, coma, tachycardia (rapid heart rate), diaphoresis (excessive sweating), tremor, muscle rigidity, nausea, vomiting, diarrhea, and/or seizures. If serotonin syndrome is suspected, discontinue any serotonergic medications, and seek immediate medical attention.