Index
It is a synthetic drug that belongs to the triptan class of drugs. It is used to treat cluster headaches and migraines.
It works by narrowing the blood vessels in the brain, relieving headaches.
Do not take this medicine if you are allergic to its formula or have a history of heart problems, blood vessel disease, high blood pressure, or liver problems.
Tell your doctor if you have a history of kidney problems, seizures, breathing problems, high cholesterol, diabetes, obesity, if you are pregnant or breastfeeding, and if you are taking any other medications.
Side effects
Besides its desired effect, Sumatriptan can cause some unwanted effects as well. In such cases, you should seek medical attention immediately.
This is not an exhaustive list of side effects. Inform your doctor if you experience any adverse drug reactions.
- Neck Pain.
- Dizziness.
- Feeling of heaviness
- Drowsiness.
- Soft spot.
- Nausea.
- Dry mouth.
- Jaw pain
- Aesthesia (tingling or pricking sensation).
- Throat pain.
- Warm feeling.
Sumatriptan is available in tablet form and is most effective when taken early after a headache. Although, the injected Sumatriptan is more effective than other formulations.
Tablets content
The tablets contain Sumatriptan (succinate), an agonist of the selective 5-hydroxytryptamine receptor subtype 1. Sumatriptan succinate is chemically designated as 3- [2- (dimethylamino) ethyl] -N-methyl-indole-5-methanesulfonamide succinate.
Mechanism of action
Sumatriptan is an agonist for avascular 5-hydroxytryptamine receptor subtype 1 (probably a member of the 5-HT 1D family) with only a weak affinity for 5-HT 1A, 5-HT 5A, and 5-HT receptors. The relationship is insignificant (as measured using standard radioligand binding assays).
The vascular 5-HT one receptor subtype that activates Sumatriptan is present in the cranial arteries in both the dog and primate, in the human basilar street, and the vasculature of the human dura mater and mediates vasoconstriction.
This action in humans is correlated with migraine relief.
In addition to causing vasoconstriction, experimental data from animal studies show that Sumatriptan also activates 5-HT 1 receptors on the peripheral terminals of the trigeminal nerve that innervate the cranial vessels.
Such action may also contribute to the antimigraine effect of Sumatriptan in humans.
Interactions with other medications
Special populations
Renal insufficiency
The effect of renal impairment on the pharmacokinetics of Sumatriptan has not been examined, but a little clinical development is expected as Sumatriptan is primarily metabolized to an inactive substance.
Hepatic impairment
The liver plays a vital role in the systemic clearance of orally administered Sumatriptan. Consequently, the bioavailability of Sumatriptan after oral administration may be markedly increased in patients with liver disease.
In a small study of patients with hepatic impairment (N = 8) matched for sex, age, and weight with healthy subjects, patients with hepatic impairment had an approximately 70% increase in AUC and C max by 40 minutes earlier. We compared them to healthy ones.
Years
The pharmacokinetics of oral Sumatriptan in the elderly (mean age 72 years, two men and four women) and in patients with migraine (mean age 38 years, 25 men and 155 women) were similar to that of healthy men (mean age ), 30 years).
Gender
In a study comparing women to men, no pharmacokinetic differences were observed between the sexes for AUC, C max, t max, and half-life.
Carrera
Systemic clearance and Cmax of Sumatriptan were similar in healthy black (N = 34) and Caucasian (N = 38) male subjects.
Drug interactions
Monoamine oxidase (MAO) inhibitors
Treatment with MAO-A inhibitors generally leads to increased plasma levels of Sumatriptan.
Due to first-pass effects on hepatic and intestinal metabolism, the increase in systemic exposure after concomitant administration of an MAO-A inhibitor with oral Sumatriptan is more significant than after concurrent administration of monoamine oxidase inhibitors. (MAOI) with subcutaneous Sumatriptan.
In a study of 14 healthy women, pretreatment with an MAO-A inhibitor decreased the clearance of subcutaneous Sumatriptan.
Under the conditions of this experiment, the result was a 2-fold increase in the area under the curve of Sumatriptan plasma concentration x time (AUC), corresponding to a 40% increase in elimination half-life.
This interaction was not evident with an MAO-B inhibitor.
A small study evaluating the effect of pretreatment with an MAO-A inhibitor on the bioavailability of a 25 mg oral Sumatriptan tablet resulted in an approximately 7-fold increase in systemic exposure.
Alcohol
Alcohol consumed 30 minutes before ingestion of Sumatriptan did not affect the pharmacokinetics of Sumatriptan.
Indications and use
Sumatriptan succinate tablets are indicated to treat migraine attacks with or without aura in adults.
Sumatriptan succinate tablets are not intended for prophylactic migraine therapy or use to treat basilar or hemiplegic migraine.
The safety and efficacy of Sumatriptan succinate tablets have not been established for cluster headache, which is present in an older, predominantly male population.
Contraindications
Sumatriptan succinate tablets should not be administered to patients with a history, symptoms, or signs of cardiac, cerebrovascular, or peripheral vascular syndromes.
In addition, patients with other significant underlying cardiovascular diseases should not receive Sumatriptan succinate tablets.
Ischemic cardiac syndromes include, but are not limited to, angina pectoris of any type (for example, stable exertional angina pectoris and vasospastic forms of angina pectoris, such as Prinzmetal variant), all forms of infarction of myocardium, and silent myocardial ischemia.
Stroke syndromes include, but are not limited to, strokes of any kind and transient ischemic attacks. The peripheral vascular disease has but is not limited to ischemic bowel disease.
Because Sumatriptan Suction Tablets can increase blood pressure, they should not be given to patients with uncontrolled hypertension.
Interactions with other medications and precautions
Sumatriptan tablets should not be administered to patients with hemiplegic or basilar migraine.
Sumatriptan tablets and any medications that contain ergotamine or ergotamine (such as dihydroergotamine or methysergide) should not be used within 24 hours of each other, nor should Sumatriptan or another 5-HT agonist be present.
Sumatriptan tablets are contraindicated in patients with hypersensitivity to Sumatriptan or any of its components.
Sumatriptan tablets are contraindicated in patients with severe hepatic impairment.
Warnings
Sumatriptan succinate tablets should only be used when a precise diagnosis of migraine headache has been established.
Risk of ischemia and myocardial infarction, and other adverse cardiac events
Sumatriptan should not be administered to patients with documented ischemic or vasospastic coronary artery disease (CAD).
It is strongly recommended that Sumatriptan not be administered to patients in whom an undiagnosed CAD is not predicted by risk factors (e.g., hypertension, hypercholesterolemia, smoking, obesity, diabetes, family history of CAD).
Also, to women with surgical or physiological menopause.
Equally or administered to men over 40 years of age unless cardiovascular evaluation provides satisfactory clinical evidence that the patient is reasonably free of coronary artery disease, ischemic myocardial disease, or other significant underlying cardiovascular disease.
The sensitivity of cardiac diagnostic procedures to detect cardiovascular disease or predisposition to coronary artery vasospasm is modest at best.
For patients with predictive risk factors for CAD, who are determined to have a satisfactory cardiovascular evaluation, it is strongly recommended that the first dose of Sumatriptan tablets be administered in a physician’s office or similar and equipped medical facility.
This recommendation should be followed unless the patient has previously received Sumatriptan.
Because cardiac ischemia can occur without clinical symptoms, an electrocardiogram (ECG) should be considered on the first occasion of use during the interval immediately after Sumatriptan tablets in these patients with risk factors.
It is recommended that patients who are long-term intermittent users of Sumatriptan and who have or develop risk factors predictive of CAD, as described above, undergo periodic interval cardiovascular evaluation as they continue to use Sumatriptan.
The systematic approach described above is intended to reduce the likelihood that patients with unrecognized cardiovascular disease will be inadvertently exposed to Sumatriptan.
Cardiac events and drug-related deaths
Serious adverse cardiac events, including acute myocardial infarction, life-threatening heart rhythm disorders, and death, have been reported within hours after administering Sumatriptan Succinate injection or Sumatriptan Succinate tablets.
Considering the degree of use of Sumatriptan in patients with migraine, the incidence of these events is extremely low.
Sumatriptan can cause coronary vasospasm, and some of these events occurred in patients with no prior history of heart disease and a documented absence of CAD. The proximity of possibilities with the use of Sumatriptan supports the conclusion that some of these cases were caused by the drug.
However, the relationship is uncertain in many cases where the underlying coronary disease is known.
Premarket experience with Sumatriptan
Of the 6,348 patients with migraine who participated in premarketing controlled and uncontrolled clinical trials of oral Sumatriptan, 2 experienced adverse clinical events shortly after receiving oral Sumatriptan that may have reflected coronary vasospasm.
None of these adverse events were associated with a severe clinical outcome.
Among the more than 1,900 migraine patients who participated in premarketing controlled clinical trials of subcutaneous Sumatriptan, eight patients experienced clinical events during or shortly after receiving Sumatriptan that may have reflected coronary artery vasospasm.
Six of these eight patients had ECG changes consistent with transient ischemia but without accompanying clinical signs or symptoms. Of these eight patients, 4 had findings suggesting CAD or predictive risk factors for CAD before inclusion in the study.
Among approximately 4,000 patients with migraine who participated in controlled and uncontrolled clinical trials of Sumatriptan nasal spray, one patient experienced an asymptomatic subendocardial infarction possibly following a coronary vasospastic event.
Post-marketing experience with Sumatriptan
Serious cardiovascular events, some of which have resulted in death, have been reported associated with Sumatriptan succinate injection or Sumatriptan succinate tablets.
However, the uncontrolled nature of post-marketing surveillance makes it impossible to determine the proportion of reported cases caused by Sumatriptan or to assess causality in individual cases reliably.
From a clinical point of view, the longer the latency between the administration of Sumatriptan and the onset of the clinical event, the less likely the association is causal.
Consequently, interest has focused on events that begin within 1 hour of the administration of Sumatriptan.
Cardiac events that have been observed to appear in the first hour after Sumatriptan administration include: coronary artery vasospasm, transient ischemia, myocardial infarction, ventricular tachycardia, ventricular fibrillation, cardiac arrest, and death.
Some of these events occurred in patients who had no CAD findings and represented the consequences of coronary artery vasospasm.
However, among the national reports of serious cardiac events within 1 hour of Sumatriptan administration, almost all patients had predictive risk factors for CAD and the presence of significant underlying factors.
Drug-associated cerebrovascular events and deaths
Cerebral hemorrhage, subarachnoid hemorrhage, cerebrovascular accidents, and other cerebrovascular events have been reported in patients treated with oral or subcutaneous Sumatriptan, and some have resulted in deaths.
The Sumatriptan’s relationship to these events is uncertain. In several cases, it seems possible that the cerebrovascular events were primary; Sumatriptan was administered with the incorrect belief that the symptoms experienced were a consequence of the migraine when they were not.
As with other acute migraine therapies, before treating headaches in patients who have not been diagnosed as migraineurs with atypical symptoms, care must be taken to exclude other potentially serious neurological conditions.
Other events related to vasospasm
Sumatriptan can cause vasospastic reactions other than coronary artery vasospasm. Peripheral vascular ischemia and colonic ischemia with abdominal pain and bloody diarrhea have been reported.
Sporadic cases of transient and permanent blindness and significant partial vision loss have been reported using Sumatriptan. Visual disturbances can also be part of a migraine attack.
Serotonin syndrome
A life-threatening serotonin syndrome development can occur with triptans, including treatment with Sumatriptan, particularly during combined use with selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs).
Suppose concomitant treatment with Sumatriptan and an SSRI (e.g., fluoxetine, paroxetine, sertraline, fluvoxamine, citalopram, escitalopram) or SNRI (e.g., venlafaxine, duloxetine) is clinically warranted. In that case, careful patient observation is recommended, particularly during the start it increases.
Symptoms of serotonin syndrome can include:
- Changes in mental status (e.g., agitation, hallucinations, coma).
- Autonomic instability (e.g., tachycardia, labile blood pressure, hyperthermia).
- Neuromuscular aberrations (eg, hyperreflexia, incoordination).
Increased blood pressure
A significant elevation in blood pressure, including hypertensive crisis, has been reported rarely in patients with and without a history of hypertension.
Sumatriptan is contraindicated in patients with uncontrolled hypertension.
Sumatriptan should be cautioned in patients with controlled hypertension as transient increases in blood pressure and peripheral vascular resistance have been observed in a small proportion of patients.
Concomitant drug use
In patients taking MAO-A inhibitors, the plasma levels of Sumatriptan achieved after treatment with the recommended doses are seven times higher after oral administration than those obtained under other conditions.
Consequently, concomitant administration of sumatriptan succinate tablets and an MAO-A inhibitor is contraindicated.
Hypersensitivity
On rare occasions, hypersensitivity reactions (anaphylaxis / anaphylactoid) have occurred in patients receiving Sumatriptan.
Such reactions can be life-threatening or fatal. In general, hypersensitivity reactions to medications are more likely to occur in individuals with a history of sensitivity to multiple allergens.
Precautions
General
Chest discomfort and stiff jaw or neck have been reported after using Sumatriptan succinate tablets and have also been reported infrequently after administration of Sumatriptan nasal spray.
Tightness in the chest, jaw, or neck is relatively joint after administration of Sumatriptan injection.
Only rarely have these symptoms been associated with ischemic changes on the ECG.
However, because Sumatriptan can cause coronary artery vasospasm, patients with signs or symptoms suggestive of angina after Sumatriptan should be evaluated for the presence of CAD.
Evaluation will also establish a predisposition to Prinzmetal variant angina before receiving additional doses of Sumatriptan, and they should be monitored electrocardiographically if similar symptoms are resumed and recur.
Sumatriptan should also be administered with caution to patients with conditions that may impair the absorption, metabolism, or excretion of drugs, such as damaged liver or kidney function.
There have been rare reports of seizures after administration of Sumatriptan.
Sumatriptan should be used with caution in patients with a history of epilepsy or conditions associated with a lowered seizure threshold.
Care must be taken to exclude other potentially serious neurological conditions before treating headaches in patients who have not been diagnosed with migraine or experienced an atypical headache.
There have been rare reports in which patients received Sumatriptan for severe headaches that were later secondary to an evolving neurological injury.
For a given attack, if a patient does not respond to the first dose of Sumatriptan, the diagnosis of migraine should be reconsidered before administering a second dose.
Overuse of acute migraine treatments has been associated with exacerbation of headache (medication abuse headache) in susceptible patients. Withdrawal of therapy may be necessary.
Binding to tissues containing melanin
In rats treated with a single subcutaneous dose (0.5 mg/kg) or oral dose (2 mg/kg) of radiolabeled Sumatriptan, the elimination half-life of radioactivity from the eye was 15 and 23 days, respectively, suggesting that Sumatriptan and its metabolites bind to melanin in the eye.
Because there could be a build-up in melanin-rich tissues over time, this raises the possibility that Sumatriptan may cause toxicity in these tissues after prolonged use.
However, no retinal effects related to Sumatriptan treatment were observed in any oral or subcutaneous toxicity studies.
Although no systematic monitoring of ophthalmological function was performed in clinical trials, no specific recommendations for ophthalmological tracking are offered.
Corneal opacities
Sumatriptan causes corneal opacities and defects in the corneal epithelium in dogs; This raises the possibility that these changes could occur in humans.
