Sumatriptan (Nasal Route)

Sumatriptan is a rapid relief nasal medicine in the triptan class of drugs, used to treat acute migraine headaches with or without aura in adults.

Overview

Sumatriptan (Imitrex) is a prescription drug launched in 1993 after approval from the US Food and Drug Administration (FDA). It is available in spray and powder forms and is prescribed for the treatment of acute migraine headaches in adults.

A migraine with aura (classic migraine) comes with disabling warning symptoms before it starts, such as disturbed vision, head pain, sensitivity to light and sound, nausea and vomiting. A migraine without aura (common migraine) begins without warning symptoms.

The drug is proven to be more effective when it is taken as soon as the headache pain begins. Even if warning symptoms of a coming migraine (an aura) are present, patients should wait until the headache pain starts before using it. It treats the headache once it sets in, but does not prevent it or reduce the number of attacks.

Results vary patient to patient, but even a single intranasal dose may effectively relieve the headache and associated symptoms. Once absorbed into the body, the medication aborts the migraine by narrowing the blood vessels in the brainstem.

Conditions Treated

  • Acute migraine headaches

Type of Medicine

  • Triptan

Side Effects

Along with its needed effects, Sumatriptan may cause some unwanted side effects, including effects of a serious allergic reaction. Not all of the listed side effects may occur in a patient, but some that do occur may require medical attention.

Serious allergic reaction

A serious type of allergic reaction called, anaphylaxis, may be caused during treatment. Anaphylaxis requires emergency medical attention. The most serious signs of this reaction are:

  • Hives on the skin with swelling
  • Irregular breathing that is very fast
  • Fainting
  • Breathing problems such as gasping for breath
  • Change in the color of the skin or the face
  • Irregular heartbeat or pulse that is very fast
  • Swelling or puffiness of the eyelids or the area around the eyes

Also, tell your doctor immediately if any of the side effects below will occur.

Less likely to occur:

  • chest pain that is mild
  • Problems swallowing
  • Feeling of pressure, heaviness or tightness in the chest or neck
  • Heavy heartbeat
  • Itching or bumps, rash or hives on the skin

Rarely occur:

  • Seizures
  • Pain in the chest that is severe
  • Breathing that is fast or irregular
  • Swelling or puffiness of the face or lips, eyelids or around the eyes
  • Difficulty breathing
  • Change of color of the skin or face

The following side effects may occur. They may not require medical attention and generally go away during treatment as the body gets used to the medicine.

More likely to occur:

  • Discomfort (especially in the throat, mouth, tongue, jaws, sinuses or nose)
  • Change in taste
  • Feeling dizzy
  • Soreness, burning, pain or a discharge in the nose
  • Feeling drowsy
  • Feeling weak or cold
  • Nausea or vomiting
  • Feeling lightheaded
  • Stiffness, aches or cramps in the muscles
  • Feeling flushed
  • Bad or unusual aftertaste
  • Feelings of warmth, hotness, burning, tingling, numbness or tightness

Less likely to occur:

  • Feeling as if you or your surroundings are moving
  • Feeling as if you are spinning

Less likely or rarely occurs:

  • Feeling worried or anxious
  • Turning sensation
  • Sense of discomfort in the throat and nasal cavity
  • Feeling unusually tired or ill
  • Changes in your vision

Serious side effects

Some patients have experienced sudden or severe abdominal or stomach pain or bloody diarrhea after using this medicine. Tell your doctor right away if you have these symptoms. The risk of stroke, abnormal heart rhythm, angina or heart attack may increase while taking this drug.

If you are at a higher risk for heart problems or stroke, your doctor may perform a heart exam before prescribing the medicine. Your doctor may also decide to have you take your first dose in the office or clinic to monitor for serious adverse reactions.

The following side effects may be symptoms of a heart problem. Call your doctor immediately if you experience any of them:

  • Difficulty breathing
  • Irregular heartbeat
  • Discomfort or pain in the chest
  • Discomfort or pain in the neck, arms, jaws, shoulders or back
  • Nausea or vomiting
  • Unusual sweating

The following side effects may be symptoms of a stroke. Call your doctor immediately if you experience any of them:

  • Confusion
  • Difficulty in speaking
  • Unable to see clearly
  • Headaches
  • Unable to move facial muscles, legs or arms
  • Unable to speak
  • Slow or slurred speech

All the possible side effects are not listed here. If you notice others not listed, or if any side effect continues or becomes bothersome, let your doctor know, as you can ask about ways to prevent or reduce these and other adverse effects.

You can call the FDA on 1-800-FDA-1088 to report side effects.

Dosage

Use this medication at the first sign of a migraine, as directed by your doctor. Your dose and other directions will be on the prescription label on the package. The patient information leaflet, which comes in the medicine packet, will give you more information about the medicine and a full list of side effects that you may experience from taking it.

If you are still unsure about what to do, ask your doctor or pharmacist for further advice.

The nasal spray

Remove the medicine from the blister packaging right before use.

The dosage for adults may be 5 mg, 10 mg or 20 mg, in different configurations: one 5 mg dose into one nostril, two 5 mg sprays in one nostril or one 5 mg spray in each nostril, or one spray of 20 mg into one nostril. Another spray (5 mg, 10 mg, or 20 mg) may be used if it has been at least two hours since the last spray. No more than 40 mg should be used in a 24 hour period.

The nasal powder

Adults should take 22 mg per day - two nosepieces, one in each nostril. You may take another 22 mg dose if it has been at least two hours since your last dose. No more than 44 mg (equaling four nosepieces) should be used in a 24 hour period.

Sumatriptan spray or powder is not recommended for children. If necessary, use and dosage must be determined by a doctor. The safety and efficacy of this medicine are not established for patients over 65.

How to administer the nasal spray:

  • Blow your nose if it feels blocked, or if you have a cold. Place yourself in a comfortable position. You may decide to sit down.
  • Open a blister pack and remove a nasal spray. Gently hold the nasal spray between your fingers and thumb. Avoid pressing the plunger. Using your index finger, gently press down on one nostril until you are unable to breathe through it. Breathe out gently through your mouth.
  • Place the nozzle of the nasal spray into the other nostril. Keep sliding it upwards very gently and as far as feels comfortable. Stop as soon as you feel any discomfort in the nose. Close your mouth while holding your head in its upright position. While still pressing down on the other nostril, press the plunger firmly with your thumb. Do this while breathing in gently through the nostril in which the nozzle was inserted.
  • With your head still upright, continue to breathe in gently through your nose and out through your mouth. Repeat for about 10 - 20 seconds. Avoid breathing in deeply. Remove your finger from the other side of your nose. Remove the nasal spray nozzle from your nostril.
  • Your nose may feel wet inside and you may experience a slight 'taste' after using the spray. These will go away shortly afterward. Avoid spraying the medicine into your eyes.

Your nasal spray should now be empty. Safely dispose of the empty spray container as instructed in the leaflet or by a healthcare professional.

How to administer the nasal powder:

The device used to administer the medicine works when you blow powerfully into it.

  • Remove the disposable nosepiece from the packaging right before use.
  • Follow the directions in the patient information leaflet to prepare the device for use.
  • Insert the nosepiece into the nostril until its snug, but comfortable. Rotate the device and then insert the mouthpiece between the lips.
  • Blow forcefully through the mouthpiece. This should push the medicine up into the nasal cavity.
  • Remove the nosepiece by pressing on the clear tab; discard right away by throwing it into the trash can.
  • Complete your dosage by inserting another nosepiece into the other nostril and repeating the same steps.

While using sumatriptan, it is very important that your doctor check your progress at regular visits. This will allow your doctor to see if the medicine is working properly and determine whether you should continue to use this or an alternative medicine.

Missed dose

This medication is used only when needed for an existing migraine.

Overdose

If the medicine does not relieve your migraine, do not take extra doses. If you or someone has overdosed and has serious symptoms, such as passing out or trouble breathing, call 911 right way. You may also call the Poison Control Center at 1-800-222-1222.

Interactions

Your doctor may tell you whether the use of tobacco, alcohol or certain foods may affect the way your medicine works.

Using other drugs during treatment with sumatriptan may change how it works or increase the risk of serious side effects. The following drugs may severely interact with the anti-migraine medication. They are listed due to their potential to cause significant interaction.

MAO inhibitors

These should not be taken during treatment with this medication. Doing so may cause a serious, possibly fatal, interaction. The MAO inhibitors include:

  • Moclobemide
  • Isocarboxazid
  • Rasagiline
  • Linezolid
  • Safinamide
  • Methylene blue
  • Phenelzine
  • Selegiline
  • Procarbazine
  • Tranylcypromine

Drugs that increase serotonin

The risk of serotonin syndrome/toxicity increases if you are also taking other drugs that increase serotonin. Such drugs include:

  • MDMA/ecstasy (a street drug)
  • St. John's Wort
  • Fluoxetine/Paroxetine (SSRI antidepressant)
  • Duloxetine/Venlafaxine (SNRI antidepressant)

Other triptan and ergotamine drugs

Ergotamine medicines, such as dihydroergotamine, or other triptan drugs, such as zolmitriptan and rizatriptan, may interact with sumatriptan.

Your doctor may decide to schedule your sumatriptan dose at times different from when you take your other medications. This may lessen the chance of serious adverse interaction.

The following other medicines should not be used with sumatriptan. Your doctor may change some of them or adjust the dose to reduce the chance of adverse interaction.

  • Eletriptan
  • Methylergonovine
  • Ergoloid Mesylates
  • Naratriptan
  • Ergonovine
  • Bromocriptine
  • Furazolidone
  • Iproniazid

These medicines are not recommended for use with sumatriptan, but their use may be required. Your doctor should take the necessary precautions to ensure the dose of each medicine you take is proper and safe.

  • Tramadol
  • Melitracen
  • Amineptine
  • Vortioxetine
  • Buprenorphine
  • Clomipramine
  • Dasabuvir
  • Lofepramine
  • Desvenlafaxine
  • Meperidine
  • Doxepin
  • Escitalopram
  • Nortriptyline
  • Fentanyl
  • Amoxapine
  • Fluvoxamine
  • Amitriptylinoxide
  • Granisetron
  • Imipramine
  • Levomilnacipran
  • Dibenzepin
  • Sibutramine
  • Milnacipran
  • Dexfenfluramine
  • Tianeptine
  • Mirtazapine
  • Ziprasidone
  • Oxycodone
  • Nefazodone
  • Citalopram
  • Trazodone
  • Desipramine
  • Opipramol
  • Reboxetine
  • Sertraline
  • Tapentadol
  • Palonosetron
  • Amitriptyline
  • Lorcaserin
  • Trimipramine
  • Vilazodone
  • Dolasetron
  • Protriptyline

Other medical problems

The medical problems listed below may cause adverse interaction. Tell your doctor if you have any of them.

Sumatriptan should not be used in patients with any of these conditions:

  • Heart or blood vessel problems
  • Peripheral vascular disease
  • Ischemic bowel disease

Sumatriptan should be used with caution in patients with any of these conditions:

  • Bleeding problems, including of the stomach or intestines
  • Blurry vision
  • Mental disorders
  • Raynaud's syndrome

Warnings

The drug is to be used only after a clear diagnosis by a doctor. It is not recommended for persistent, long-term use, due to the risk of medicine-induced headaches. It should also not be used in people with medical problems, such as heart disease or high blood pressure.

Patients who have not been previously diagnosed as migraineurs and who may have atypical symptoms should be carefully examined by a doctor to exclude other potentially serious neurological conditions.

Ensure you tell your doctor or pharmacist about the following before using the medicine. They may affect the use of this drug or may place you at risk for serious adverse effects:

  • Allergies, including any allergic reaction to the medicine or its inactive ingredients
  • Medical history, including other types of headaches you experience, heart problems or previous heart attack, liver disease, stroke or mini-stroke, seizures or epilepsy, and blood circulation problems in any part of the body
  • Medical conditions, such as any that can increase the risk of heart problems - high blood pressure, high cholesterol, diabetes, family history of heart disease, or obesity may put you at a higher risk for heart problems
  • Medicines you're taking, including prescription and non-prescription drugs, vitamin supplements, and herbal or nutritional products

Geriatrics

Elderly patients may be more vulnerable to the side effects of this medicine. They are more likely to experience increased blood pressure and heart problems because their body may be more sensitive to the drug.

Pregnancy

Pregnant women should use this medicine only when necessary and prescribed by a doctor.

Breastfeeding

This drug is known to pass into breast milk and may affect a breastfeeding infant.

Considering these limitations, geriatric patients and pregnant or breastfeeding women should discuss with their doctor the risks and benefits of using this medication. Use and dosage must be determined by a doctor and may vary from patient to patient.

People who should not use this drug:

  • Those who have uncontrolled high blood pressure (the medicine may raise blood pressure)
  • Patients who suffer from hemiplegic migraine or basilar migraine
  • Patients with acute migraine headaches who are at increased risk for obstruction of blood flow to the brain - a transient ischaemic attack or cerebrovascular accident
  • Those taking monoamine oxidase-A inhibitors or MAO-A inhibitors, such as Nardil (powerful antidepressants), or who have taken MAO-A inhibitors within the past 14 days
  • Elderly patients or people with severe liver impairment
  • Patients who have, within the past 24 hours, taken other migraine medications, including triptan drugs, such as almotriptan, zolmitriptan, and frovatriptan, and ergo-type drugs, such as ergotamine and methysergide

Do not start, stop or change the dosage of Sumatriptan without your doctor's approval, and do not take other migraine treatments (such as other triptans or ergotamine) while taking this medicine.

Take this medicine only after the headache pain begins. It does not prevent a migraine headache from coming on and should not be used to treat the warning symptoms. Keep the nasal spray in the blister package until ready for use.

Do not drive, use machinery, or do any activity that requires alertness if you feel dizzy or drowsy after taking this drug. Wait until you are sure you can perform such activities safely.

Avoid using alcohol during treatment as it can increase the risk of side effects.

Before you have a surgery or dental treatment, tell the person carrying out the treatment which medicines you are taking.

Do not take more doses of the medication than prescribed. If your dose is not working, your doctor may recommend another dose at least two hours after the first dose. Do not take more than 40 mg of the spray or 44 mg of the powder in any 24 hour period.

Sumatriptan should not be taken regularly for more than 10 days per month or two or three days a week. This can reduce the threshold for the migraine as well as increase the risk for serious side effects.

Call your doctor immediately if the headache gets worse.

Do not share this medication with anyone even if they have similar symptoms.

Helpful tips

Certain foods, beverages, stress or lifestyle habits may trigger migraine headaches. To determine what triggers your migraine attacks, you may keep a migraine diary. You may note the how often the headache occurs, where you were and what you were doing when it started, and what you ate and drank that day. You may begin to see a pattern of the attacks. This can help you do or avoid the things that may trigger your migraine attacks.

You can also note how often per week you take sumatriptan or other painkillers for your headaches. If you use the medicine or other painkillers on more than two days a week on a regular basis, you may be at risk of medication-induced migraine headaches.

Tell your doctor or healthcare professional about your findings and ask about ways to reduce the number of attacks you experience.

Storage

This medication should be kept in the sealed blister package to protect it from heat and light. Keep all medication away from children and pets. Keep from freezing.

Properly discard this product when each container is empty, expired, or no longer needed. Check the medicine package for complete instructions on how to store and dispose of it or ask your pharmacist or local waste disposal company.

Summary

Prior to sumatriptan, acute migraine headaches were treated with painkillers that did not specifically target migraine, such as acetaminophen and ibuprofen. A medicine specially created to treat migraine was necessary due to the disability the attacks can cause to migraineurs.

Sumatriptan effectively changed the way migraines are treated, particularly in migraineurs whose symptoms require rapid relief from a fast-acting formula. The medicine targets migraine headaches and is proven to provide relief, even after one dose. As effective as it is, however, the medication does not stop a migraine from coming on, such as in the case of a migraine with aura (warning symptoms). It should be used only after the headache pain is felt.

The drug is not intended for long-term treatment. Overusing it or taking it with other painkillers can cause medicine-induced headaches, lower the threshold for migraine attacks, or increase the risk for serious side effects.

Although it cannot be used to prevent a migraine from setting in, it is still an effective and rapid way to relieve acute migraine headaches and associated symptoms. If taken promptly, migraineurs can usually return to their normal routine and avoid the need for other pain medications.

Notwithstanding its shortcomings, including the risk of serious side effects and adverse interaction with other drugs or medical problems, sumatriptan is preferred in the treatment of acute migraine headaches with or without aura.

 

 

Resources
Last Reviewed:
January 31, 2018
Last Updated:
February 10, 2018
Content Source: