sumatriptan: clinical use

Prescribing considerations

• Confirm a clear migraine diagnosis; investigate atypical or previously unevaluated neurological symptoms before treatment.
• Assess cardiovascular risk in patients with significant ischaemic risk factors.
• Consider medication-overuse headache when headaches become frequent or daily during regular acute-treatment use.
• Use caution with controlled hypertension, seizure risk, mild-to-moderate hepatic impairment, renal impairment or sulphonamide hypersensitivity.

Contraindications and cautions

• Hypersensitivity to sumatriptan or an excipient
• Previous myocardial infarction, ischaemic heart disease, coronary vasospasm, peripheral vascular disease or symptoms consistent with cardiac ischaemia
• Previous stroke or transient ischaemic attack
• Severe hepatic impairment
• Moderate or severe hypertension, or mild uncontrolled hypertension
• Concomitant ergot derivatives, another triptan or another 5-HT1 agonist
• Concurrent or recent monoamine oxidase inhibitor therapy

Monitoring

• Monitor for persistent chest symptoms, blood-pressure effects, hypersensitivity, and neurological or vascular adverse events.
• When combined with an SSRI or SNRI, observe for features of serotonin syndrome.
• Review headache pattern and acute-medicine use for possible medication-overuse headache.

Clinical pharmacology

A selective vascular 5-HT1 receptor agonist. Antimigraine activity is attributed to cranial vasoconstriction and inhibition of trigeminal nerve activity.

Formulation and product differences

• The selected product is an aqueous, single-use intranasal device.
• The nasal route may be useful when nausea or vomiting makes oral administration difficult.
• Unpleasant taste and temporary nasal or throat irritation are particularly relevant to this formulation.

Nasal preparation

Route: Nasal

Strengths: 10 mg, 20 mg