sumatriptan succinate: clinical use

Prescribing considerations

• Confirm a clear diagnosis and investigate atypical or newly changed neurological symptoms before treatment.
• Sumatriptan is for acute treatment, not prophylaxis.
• Assess cardiovascular risk before prescribing to patients with risk factors for ischaemic heart disease.
• Consider medication-overuse headache when acute headache medicines are used frequently.
• Use caution with controlled hypertension, hepatic or renal impairment, seizure susceptibility and possible sulphonamide hypersensitivity.
• Review serotonergic, vasoconstrictive and herbal medicines before prescribing.

Contraindications and cautions

• Previous myocardial infarction, ischaemic heart disease, coronary vasospasm or peripheral vascular disease
• Previous stroke or transient ischaemic attack
• Moderate or severe hypertension, or uncontrolled mild hypertension
• Severe hepatic impairment
• Concurrent or recent monoamine oxidase inhibitor treatment
• Concurrent ergotamine, ergot derivatives, another triptan or another serotonin receptor agonist
• Hypersensitivity to sumatriptan or product excipients

Monitoring

• Review persistent or severe chest symptoms before any further use.
• Monitor blood pressure and cardiovascular symptoms where clinically indicated.
• Observe for serotonin syndrome when combined with serotonergic medicines.
• Review headache frequency and acute-treatment use for medication-overuse headache.
• Confirm injection technique and safe sharps disposal.

Clinical pharmacology

A selective 5-HT receptor agonist that produces cranial vasoconstriction and inhibits trigeminal activity. It is metabolised mainly by monoamine oxidase A to an inactive metabolite; subcutaneous administration has high bioavailability and a faster onset than oral administration.

Formulation and product differences

• Selected tablets are licensed for migraine attacks but not cluster headache.
• Selected injections are licensed for migraine and cluster headache and are administered subcutaneously.
• Injection may be useful when nausea or vomiting makes oral administration impractical.
• Injection devices are product-specific; users should follow the supplied instructions.
• The Imigran pre-filled syringe needle shield may contain natural latex rubber; check suitability in latex-sensitive patients.
• Subcutaneous preparations must not be administered intravenously.

Tablet

Route: Oral

Strengths: 50 mg, 100 mg

Injection

Route: Parenteral

Strengths: 3 mg/0.5 mL, 6 mg/0.5 mL