Sumatriptan – Oral

Sumatriptan is a form of pain relief which is prescribed specifically to patients who suffer from migraines and cluster headaches.

Overview

Sumatriptan belongs to a group of medications which are known as triptans. It is prescribed to patients who suffer from migraines and cluster headaches in order to relive them from the pain and other associated symptoms. It causes the blood vessels in the head to narrow, which restricts the way in which the brain receives pain signals. When the brain does not receive such strong pain signals, the release of natural defense chemicals by the body is restricted. These chemicals are usually what causes the nausea, vomiting and severe pain associated with migraines. Stopping the brain from releasing such chemicals prevents the patient from experiencing such severe symptoms and helps them to carry on

As sumatriptan works by blocking these pain signals, it is only useful once a headache has already started to come on. Sumatriptan is prescribed to treat migraines which are already in progress. It is only used to treat severe headaches which have already started, it will not have a preventative effect on migraines or reduce the frequency of migraines. It should therefore only be taken once the first symptoms of a migraine are experienced and shouldn’t be taken on a regular basis. Sumatriptan will not have any effect on reducing the regularity with which a patient experiences migraines, nor will it do anything to prevent them in the future. It is simply used as a relief from symptoms in the moment.

Due to the way in which it blocks pain signals, sumatriptan interferes with the serotonin in the brain. On its own, this is not dangerous, however, if combined with other drugs which also have the same effect on increasing serotonin levels, a condition called ‘serotonin toxicity’ or ‘serotonin syndrome’ can develop. This can be an extremely serious condition and occurs when the brain has produced too much serotonin. If patients know that they are taking other medication which increases their serotonin levels, or recreational drugs which have the same effect, they should speak with their doctor to determine whether sumatriptan is still the best course of treatment in their case.

Sumatriptan most commonly comes in the form of tablets or capsules which are swallowed by the patient as soon as they feel a migraine coming on. These tablets are swallowed with water or another liquid but do not need to be taken with food. Although tablets are most common, this drug is also available in the form of an injection. Some patients use the oral tablets as a backup for the injection if the medication is not available for some reason, or if a migraine is more severe and the patient requires additional pain relief.

Conditions Treated

  • Migraines
  • Severe Headaches
  • Cluster Headaches

Type of Medicine

  • Triptan

Side Effects

Your doctor should make you aware of any possible side effects at the time of prescribing you a drug, but it is important to remember that healthcare professionals will prescribe a certain drug because they believe that the benefits will outweigh any possible side effects of taking a drug. Most people who take Sumatriptan do not experience serious or harmful side effects as a result of the drug, but there is a small minority of patients who do.

The most common side effects associated with Sumatriptan include the following:

  • Hot flushes
  • Pins and needles or tingling sensations
  • Numbness
  • Unusual tiredness
  • Muscle weakness
  • Drowsiness
  • Dizziness and light-headedness
  • Tightness in the jaw, chest or neck

None of the above is likely to cause any serious or lasting damage to a patient, however, if they do not go away or they begin to worsen, patients should seek medical attention as soon as possible.

The use of sumatriptan to treat migraines has, in a few cases been linked to some more serious side effects. These include:

  • Fingernails and toenails turning blue
  • Very cold hands and feet
  • Changes in the patient’s ability to hear
  • Mental instability
  • Changes in mood
  • Increased blood pressure

Patients taking sumatriptan regularly are most at risk of these more serious side effects. These patients, in particular, should make sure that they are checking their blood pressure regularly in order to spot any irregularities. They should also monitor their hearing to make sure that there are no changes and keep tabs on their mental health. If you are taking sumatriptan and you start to experience any of the symptoms listed above, you should seek medical attention and make sure that your doctor knows that you have been taking sumatriptan.

It is extremely uncommon for people to have an allergic reaction to sumatriptan, however, it does happen occasionally.

Symptoms of an allergic reaction include:

  • Rashes
  • Itching
  • Hives
  • Swollen face, tongue and/or throat
  • Dizziness and nausea
  • Difficulty breathing

If patients start to experience any of the symptoms listed above after having taken sumatriptan, they should seek medical help as soon as possible and cease taking the drug until an allergic reaction has been ruled out.

Sumatriptan works by increasing the levels of serotonin in the brain. In very rare cases, the serotonin levels can become dangerously high and cause a condition called serotonin toxicity. Patients are at particular risk of serotonin toxicity if they are taking other drugs which also increase the levels of serotonin in the brain. Patients who experience one or more of the symptoms associated with serotonin toxicity should seek medical attention urgently.

Symptoms of serotonin toxicity:

  • Fast or irregular heartbeat
  • Sudden lack of coordination
  • Dizziness and light-headedness
  • Hallucinations
  • Severe and prolonged vomiting and diarrhea
  • Muscle spasms
  • Agitation
  • Nausea
  • Restlessness

Dosage

Sumatriptan is only available via prescription, and the dosage required will vary from patient to patient. Doctors will assess the specific condition and individual needs of a particular patient before setting a dose tailored to that specific person.

Dosage prescribed for migraines

Adults are usually prescribed doses of 25 mg or 50 mg of sumatriptan to be taken as soon as the first signs of a migraine coming on. Each individual will have different warning signs for their migraines, but the initial symptoms usually include vomiting, nausea, and sensitivity to light.

Tablets should be swallowed whole, with water or other liquids. It is not necessary to eat before taking sumatriptan.

Increasing the dose to 100 mg is sometimes advised, however it does not always provide more relief than a 50 mg dose of sumatriptan. As the dose increases so do the risk and severity of side effects.

If patients feel some response to their migraine, but require further relief, a second dose may be taken within 2 hours after the initial dose. Patients should not take doses which amount to more than 200 mg in a period of 24 hours or less. The drug has been tested to safely treat up to 4 headaches within a 30 day period. If patients are experiencing migraines more frequently than this, they should ask their doctor whether sumatriptan is the best course of treatment.

Dosage prescribed for cluster headaches

Cluster headaches are usually treated with an injected form of sumatriptan rather than via the oral route. However, the tablet form can be used as a back up to the injection. If the drug is being used as a backup to the sumatriptan injection, patients can take oral sumatriptan, but not until 2 hours after the injection. Patients should not take more than 100 mg of oral sumatriptan in the 24 hours after having received an injection of sumatriptan.

This medication is not suitable for children.

The dose may be adjusted if patients currently have kidney or liver problems. The dose may be reduced in elderly patients in order to limit the strain placed on the kidney, liver, heart, and lungs.

Interactions

Whenever two or more pharmaceuticals are taken at the same time, there is always the risk of interactions between the different drugs. Drugs interacts can affect the way in which the chemicals in the drugs work within the body, making either or all of the drugs less effective at treating medical conditions. In some cases, drug interactions can increase the chance of side effects, or cause completely different conditions which could have potentially harmful consequences.

It is vital that patients keep a comprehensive and fully up-to-date list of all of the drugs they are taking. This list should include all prescription and non-prescription medications as well as any vitamins or dietary supplements. This will help doctors and pharmacists to prescribe more effectively and will also help doctors to diagnose issues if any of the drugs start to interact. It is also imperative that patients do not change their dosage or start or stop taking medications without first consulting a qualified healthcare professional.

It is not possible to list all of the drugs which may interact with sumatriptan, some of which may not even be known. It is also important to remember that doctors and pharmacists prescribe drugs in their patients’ best interests. They will prescribe drugs when they believe that the benefits of taking them outweigh the risks. If you are worried about the interaction between two or more of the medications you are taking, speak to your doctor or pharmacist for advice.

MAO inhibitors

MAO inhibitors are drugs which are often used to treat depression. When combined with sumatriptan there is the possibility of a serious, and potentially fatal, interaction. All of the following drugs (and all other MAO inhibitors) should be avoided:

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

Patients should not take any MAO inhibitors alongside sumatriptan. It is usually recommended to have a period of two weeks between using MAO inhibitors and sumatriptan, but doctors will be able to advise patients according to their particular situation and condition.

Increased serotonin

Sumatriptan increases the levels of serotonin in the brain. There are other drugs which also have this effect on the body, and these can cause serious interactions with sumatriptan. These drugs include recreational drugs such as MDMA, ecstasy as well as prescribed and non-prescribed anti-depressants and extracts such as St. John’s Wort. Taking too many drugs which increase serotonin levels can lead to serotonin toxicity which can be fatal if not treated effectively in the early stages.

Ergotamine medication

Ergotamine is an ingredient used in treatments for thrombosis, gangrene and vascular stasis. When taken alongside sumatriptan it can increase the chances of side effects from both drugs. In order to minimize the increased possibility of side effects, patients should separate their doses of the different drugs so that they are not entering the body at the same time. Patients should also seek medical advice to ensure that this is the correct course of treatment and to be given instructions as to how long to wait between doses of each drug.

If patients are worried about the interactions between any two or more of the drugs that they have been prescribed, they should raise their concerns which their doctor or pharmacist at their next appointment. If they start to feel symptoms associated with any of these interactions then they should seek medical attention right away and make sure that the doctor is aware of all of the medications they are currently taking.

Warnings

In some cases, sumatriptan can have a negative effect on pre-existing and potential underlying medical conditions of patients who take the drug. Patients should always make sure that their doctor has a full and complete medical history, as well as an up-to-date list of all of the medication they are taking.

Inform your doctor or pharmacist if any of the following statements are true:

  • You are allergic to sumatriptan or any of the active ingredients listed on the packaging
  • You have blood circulation problems, whether these have been diagnosed or not
  • You have, or have ever had, an irregular heartbeat
  • You have suffered a heart attack
  • You currently have or have ever had liver disease
  • You suffer from epilepsy or have a history of having seizures
  • You have ever had a stroke or a transient ischemic attack (mini-stroke)
  • You are prone to chest pain
  • Your blood pressure is consistently high
  • There is a history of heart disease within your family
  • You have high cholesterol
  • You are a smoker
  • You are diabetic (type 1 and type 2)
  • You are postmenopausal

If one or more of the statements listed above are true, these could change the way in which sumatriptan is processed within your body. There may be an increased risk of side effects, the drug may not be as effective and/or sumatriptan could have a harmful effect on your health overall. Doctors will be able to make a final call as to whether sumatriptan is appropriate in your case, as long as you are able to provide them with all of the information they require to make a decision. It may be that sumatriptan is the best option or it may be that the doctor feels that there is a more appropriate course of treatment.

Surgery

If you have a scheduled surgery it is important to make sure that the surgeon is aware of all of the drugs currently being taken. Some pharmaceuticals change the way in which the body responds to trauma and this can have an impact on surgical procedures.

Operating machinery

There is a possibility that sumatriptan can make patients dizzy and/or drowsy after taking it. If this is the case, the patient should not drive a vehicle, operate machinery or engage in any activity which requires them to be fully alert until such symptoms have passed. Patients should not engage in these activities until they are certain that they can do so in a safe manner.

Alcohol

Alcohol can increase the severity of some of the side effects associated with sumatriptan. If a person drinks alcohol whilst still under the effects of sumatriptan it is possible that they will feel drunk more quickly or that the alcohol will affect them in different ways than usual. Alcohol consumption should be limited whilst taking sumatriptan.

Pregnancy and breastfeeding

Only those pharmaceutical drugs which are strictly necessary should be taken whilst pregnant, as adult doses of medications can have an effect on unborn babies. If you are pregnant or planning to become pregnant and you are prescribed sumatriptan, discuss the details with your doctor in order to protect the baby in the best way possible.

It is possible for small amounts of sumatriptan to pass into breast milk and be consumed by the nursing baby. Breastfeeding mothers are advised to consult a doctor before taking sumatriptan.

Storage

As with all medications, sumatriptan should be stored in the container it was provided in, with a tightly closed seal where possible. The container should be clearly labeled, so as to avoid confusing sumatriptan with any other form of medication. If the patient was given instructions on dosage or how to take the medication, these instructions should be stored with the medication in case they are needed for reference purposes.

Sumatriptan tablets should be kept at room temperature, in a place where there are no large fluctuations in temperature. They should be kept somewhere dry, so that moisture cannot get into the container and contaminate the medication. This means storing the tablets somewhere other than the bathroom.

Medications should be kept out of reach of children and pets in order to prevent accidental swallowing. Patients are reminded that many pillboxes and pill minders are not child-resistant, and even very young children are able to open them with ease. It is therefore advisable to store the medication in the container provided by the doctor or pharmacist and to keep them out of reach as a precaution.

As patients could feel the onset of a migraine at any time, and sumatriptan should be taken as soon as they feel one coming on, patients may want to make sure that they have their medication on them at all times. This is fine, but the same rules still apply as when storing it in the house. Even when out and about, care should be taken to ensure that the sumatriptan is kept at room temperature and away from moisture.

If you know longer require the sumatriptan you have been prescribed, or the medication breaches its expiry date, it is important to dispose of the tablets safely. Do not throw them into the usual household waste and do not flush them down the toilet. Instead, you should engage in a medicine take-back program with your doctor or pharmacist so that the tablets can be disposed of safely without risking any harm to others.

Summary

Sumatriptan is a medication which is used extensively to treat patients who suffer from migraines and cluster headaches. It is not prescribed to be taken on a regular basis but instead is offered as a form of immediate relief available to take when patients first feel a migraine or severe headache forming. It works in the moment by restricting the size of the blood vessels in the head so that they are less able to carry pain signals to the brain. The brain then cannot react in the same way and does not release natural chemical defenses to attack the headache, some of which are responsible for the feelings of nausea and pain associated with migraines.

This is only an effective treatment in the moment and will do nothing to prevent patients from having migraines in the future. Sumatriptan is not able to reduce the frequency with which a patient experiences migraines, but it is able to relieve them of pain whilst a migraine is ongoing.

It does not usually cause side effects for patients, but in some cases, patients may experience hot flushes, pins and needles or tingling sensations, numbness, unusual tiredness, muscle weakness, drowsiness, dizziness, and light-headedness or tightness in the jaw, chest or neck as a side effect of the drug. These side effects are all relatively minor and will usually wear off as the drug leaves the system. More serious side effects associated with sumatriptan are much less common but they do occasionally occur. This is more likely to happen where patients are taking more than one drug which carries the possibility of a certain side effect. If patients are worried about the potential risk of side effects, they should discuss their concerns with their doctor, pharmacist or other healthcare professionals at their next appointment.

Allergic reactions to sumatriptan are incredibly rare but have occasionally been reported. Patients should seek immediate medical attention if they feel they may be having an allergic reaction to the drug.

Doses of sumatriptan will be tailored to the individual by doctors when making the prescription. These doses start at 25 mg and can go up to as much as 100 mg for a single dose. Doctors will usually amend the doses according to the age of the patient and their overall medical condition as well as the severity of their migraines.

 

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Last Reviewed:
January 31, 2018
Last Updated:
January 27, 2018