Sumatriptan Succinate

A to Z Drug Facts

 Action Selective agonist for vascular serotonin (5-HT) receptor subtype, causing vasoconstriction of cranial arteries.

 Indications Short-term treatment of migraine attacks with/without aura; treatment of acute cluster headaches (injection only).

 Contraindications IV use (causes coronary vasospasm); SC use in patients with ischemic heart disease or in patients with Prinzmetal angina; symptoms consistent with possible ischemic heart disease; uncontrolled hypertension; concurrent use of ergotamine-containing preparations; management of hemiplegic or basilar migraine; concurrent MAOI therapy or within 2 wk of discontinuing an MAOI.

 Route/Dosage

ADULTS: PO Recommended dose is £ 100 mg taken with fluids. Doses of 100 mg have not been proven to provide a greater effect than 50 mg. If headache returns, additional doses may be taken at intervals of ³ 2 hr up to a max of 200 mg/day. If headache returns following an initial dose with the injection, additional doses of single tablets (up to 100 mg/day) may be given with an interval of ³ 2 hr between tablet doses. SC Administer as soon as symptoms appear. Max single adult dose is 6 mg. Max dose per 24 hr is two 6 mg injections separated by ³ 1 hr. Available in autoinjection prefilled syringe devices that deliver 6 mg for easy use; however, lower doses should be used in patients who have side effects at usual dose.

ADULTS: Intranasal Administer a single dose of 5, 10, or 20 mg in 1 nostril. A 10 mg dose can be achieved by the administration of a single 5 mg dose in each nostril. If headache returns, the dose may be repeated once after 2 hr. Do not exceed a total daily dose of 40 mg.

Hepatic Function Impairment

Maximum single dose is £ 50 mg.

 Interactions

5-HT₁ Agonists (eg, Sumatriptan)

Increased risk of vasospastic reactions; therefore, coadministration of two 5-HT₁ agonists within 24 hr of each other is contraindicated.

Ergot-Containing Drugs

May cause additive prolonged vasospastic reactions. Avoid use within 24 hr of each other.

MAOIs

Use of sumatriptan with MAOIs or within 14 days following discontinuation of an MAOI is contraindicated.

Selective Serotonin Reuptake Inhibitors (Citalopram, Fluoxetine, Fluvoxamine, Paroxetine, Sertraline)

Weakness, hyperreflexia, and incoordination have been reported rarely.

Sibutramine

Serotonin syndrome, including CNS irritablilty, motor weakness, shivering, myoclonus, and altered consciousness may occur.

 Lab Test Interferences None well documented.

 Adverse Reactions

CARDIOVASCULAR: Hypertension; hypotension; bradycardia; tachycardia; palpitations; pulsating sensations; various transient ECG changes; syncope; arrhythmia; angina; coronary vasospasm in patients with history of CAD. CNS: Dizziness; vertigo; drowsiness; sedation; headache; anxiety; malaise; fatigue. EENT: Eye irritation; vision alterations; photophobia; lacrimation; throat or mouth discomfort; nasal cavity or sinus discomfort. GI: Abdominal discomfort; dysphagia; abdominal discomfort, dysphagia, mouth/tongue disorder (eg, burning of tongue, numbness of tongue, dry mouth) (intranasal). OTHER: Tingling; warm or hot sensation; burning sensation; feeling of heaviness; numbness; feeling strange; tight feeling in head; cold sensation; weakness; neck pain or stiffness; myalgia; muscle cramp; tightness or pressure in chest; injection site reaction; flushing; sweating; abnormalities in LFTs; hearing disturbances, ear infection, eye irritation, visual disturbances (intranasal).

 Precautions

Pregnancy: Category C. Lactation: Excreted in breast milk. Children: Safety and efficacy not established. Elderly: Safety and efficacy in patients > 65 yr not thoroughly evaluated. Cardiac Events/Vasoconstriction: Serious coronary events, though extremely rare, can occur after sumatriptan use. Administer first dose in health care provider’s office to patients at possible risk of unrecognized coronary disease. If symptoms consistent with angina occur, conduct ECG evaluation for ischemic changes. May cause coronary vasospasm in patients with history of CAD. Rare reports of major arrhythmias and angina symptoms. Hepatic or Renal Function Impairment: Use caution.

 Administration/Storage

Injection

• Administer via SC route. Do not give IV (can cause coronary vasospasm).
• Store at room temperature and protect from light.
• Discard any unused portion.

Oral

• Take with plenty of fluids.

Intranasal

• A single dose of 5, 10, or 20 mg administered in 1 nostril.
• Weigh the possible benefit of the 20 mg dose with the potential for a greater risk of adverse events.
• A 10 mg dose may be achieved by the administration of a single 5 mg dose in each nostril.
• If headache returns, the dose may be repeated once after 2 hr, not to exceed a total daily dose of 40 mg.
• The safety of treating an average of > 4 headaches in a 30-day period not established.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• Assess pain location, intensity, duration, and associated symptoms of migraine attack.
• Administer initial dose in health care provider’s office to patients with potential for CAD including postmenopausal women, men > 40 yr, patients with risk factors for CAD (eg, hypertension, hypercholesterolemia, obesity, diabetes, smokers, family history). Monitor BP prior to and for 1 hr after initial injection; transient increases in BP may occur during first hour. If angina occurs, monitor ECG for ischemic changes.
• Provide quiet, calm environment. Decrease stimuli, noise, light.
• Monitor for side effects and local injection site reactions.

 Patient/Family Education

• Instruct patient and family on proper technique for loading, administering medication, and disposing of autoinjector.
• Provide patient information pamphlet.
• Explain that drug is to be used during migraine attack and does not prevent or reduce number of attacks. Emphasize for treatment only of actual migraine attack.
• Teach patient to inject dose SC as soon as symptoms of migraine occur, but explain that drug may be given at any time during attack. If symptoms return, explain that second injection may be given. Tell patient to allow ³ 1 hr between injections and not to use > 2 doses in 24 hr.
• Advise patient if pain or tightness in chest or throat occur when using sumatriptan, to notify health care provider prior to using drug again. If chest pain is severe or does not go away, tell patient to notify health care provider immediately.
• Advise patient that pain or redness at injection site usually lasts < 1 hr.
• Tell patient to notify health care provider immediately if wheezing, heart throbbing, swelling of eyelids, face, or lips, skin rash, skin lumps, or hives occur.
• Instruct patient to report the following symptoms to health care provider: tingling, heat, flushing, heaviness, pressure, drowsiness, dizziness, tiredness, sickness.
• Advise patient that drug may cause drowsiness or dizziness and to use caution while driving or performing other activities requiring mental alertness.
• Advise patient that oral sumatriptan should be taken as soon as symptoms of migraine appear; a second dose may be taken if symptoms return, but no sooner than 2 hr following the first dose. For a given attack, if there has been no response to the first tablet, do not take a second tablet without first consulting the health care provider. Do not take > 300 mg in any 24-hr period.

Intranasal

• A single nasal spray into 1 nostril. If headache returns, a second nasal spray may be given ³ 2 hr after the first spray. For any attack in which patient has no response to the first nasal spray, do not use a second nasal spray without first consulting health care provider. Do not administer more than a total of 40 mg of nasal spray in any 24-hr period.

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Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts