Generic Name: Sumatriptan
Class: Selective Serotonin Agonists
VA Class: CN105
Chemical Name: C14H21N3O2S
Molecular Formula: C14H21N3O2S•C4H6O4
CAS Number: 103628-46-2
Uses for Imitrex
Imitrex Dosage and Administration
Administer sumatriptan tablets orally with fluids; swallow tablet whole.148
Administer sumatriptan/naproxen fixed-combination tablets with or without food; do not split, crush, or chew.281
Administer intranasally as a single spray into 1 nostril.249
Nasal solution unit contains only 1 spray; do not test before use.249
To administer, remove unit from package just before use.249 While sitting down, gently blow nose to clear nasal passages.249 Keep head in upright position and gently close 1 nostril with index finger; exhale gently through mouth.249 With other hand, hold unit with thumb supporting at bottom and index and middle fingers on either side of nozzle.249 Insert nozzle into open nostril about ½ inch.249 While gently inhaling through nose (with closed mouth), release spray by firmly pressing plunger.249 Remove nozzle from nostril while keeping head level for 10–20 seconds and gently inhaling through nose and exhaling through mouth; do not inhale deeply.249 Consult administration instructions provided by manufacturer before use.249
Injection pen for use with prefilled cartridges (each containing a 4- or 6-mg dose): Needle penetrates approximately 5–6 mm (¼ inch); use injection sites with an adequate skin and subcutaneous thickness to accommodate needle length (e.g., lateral thigh, upper arm).1 284
Prefilled injection pen (containing 6-mg dose): Needle projects ¼ inch following activation of device; use injection sites with an adequate skin and subcutaneous thickness to accommodate needle length (e.g., lateral thigh, upper arm).279
Prefilled needleless injection device (containing 6-mg dose): Use administration sites on abdomen (avoiding 2-inch area around the umbilicus) or thigh with an adequate subcutaneous thickness to accommodate penetration of the solution into the subcutaneous space.280 Avoid using administration sites on upper arm, since delivered dose may be suboptimal.280
In patients receiving doses other than 4 or 6 mg, only the single-dose vials containing 6 mg/0.5 mL should be used to provide the desired dose.1
25, 50, or 100 mg as a single dose.148 Individualize dosage selection, weighing the possible benefit (greater effectiveness) and risks (increased adverse effects) of the 50- or 100-mg dose; 100-mg dose may not provide substantially greater effect than 50-mg dose.148
If headache recurs or partial response occurs after initial dose, additional oral doses may be administered at intervals of ≥2 hours, up to a maximum oral dosage of 200 mg daily.148
If headache recurs after an initial sub-Q dose, additional oral doses may be administered at intervals ≥2 hours, up to a maximum oral dosage of 100 mg daily.148Oral (Sumatriptan/Naproxen)
Sumatriptan 85 mg (with naproxen sodium 500 mg) as a single dose.281
5, 10, or 20 mg as a single dose; individualize dosage selection, weighing the possible benefit (greater effectiveness) and risks (increased adverse effects) of the 20-mg dose.249 Doses >20 mg provide no additional benefit.249
To achieve a 10-mg dose, administer a single 5-mg dose into each nostril.249
If headache recurs, dose may be repeated once after 2 hours, up to a maximum dosage of 40 mg daily.249Sub-Q
≤6 mg as a single dose.1 If dose-limiting adverse effects occur with 6-mg dose, lower doses (e.g., 1–5 mg) may be given.
If headache recurs, 6-mg dose may be repeated once after ≥1 hour, up to a maximum dosage of 12 mg in any 24-hour period.1
Maximum 200 mg daily; do not exceed 100 mg daily if following an initial sub-Q dose.148
Safety of treating an average of >4 headaches per 30-day period has not been established.148Oral (Sumatriptan/Naproxen)
Maximum 2 doses (total sumatriptan dosage of 170 mg) in any 24-hour period.281
Safety of treating an average of >5 headaches per 30-day period has not been established.281Intranasal
Maximum 40 mg daily.249
Safety of treating an average of >4 headaches per 30-day period has not been established.249Sub-Q
Maximum 6 mg as a single dose; do not exceed 12 mg (i.e., two 6-mg doses given ≥1 hour apart) in any 24-hour period.1
Maximum 6 mg as a single dose; do not exceed 12 mg (i.e., two 6-mg doses given ≥1 hour apart) in any 24-hour period.1
Unpredictable increases in bioavailability following oral administration in patients with hepatic impairment.148 If oral therapy is deemed advisable in these patients, do not exceed 50 mg as a single dose.148 Avoid use of fixed-combination tablets containing sumatriptan 85 mg and naproxen sodium 500 mg, since sumatriptan dosage cannot be appropriately adjusted.281
Select dosage with caution, usually starting at the low end of the dosage range.1
Cautions for Imitrex
Wolff-Parkinson-White syndrome or cardiac arrhythmias associated with other accessory pathway conduction disorders.1
Careful Diagnosis of Migraine
Use oral or intranasal sumatriptan only in patients in whom a clear diagnosis of migraine has been established.148 249 Use sub-Q sumatriptan only in patients in whom a clear diagnosis of migraine or cluster headache has been established.1
If first migraine attack treated with sumatriptan fails to respond to the drug, reconsider diagnosis before administering sumatriptan to treat subsequent attacks.1
Exclude other potentially serious neurologic disorders before administering sumatriptan to patients not previously diagnosed with migraine or cluster headache or to those with atypical symptoms.1 61 148 236 237 249
Possible myocardial ischemia and/or infarction and coronary vasospasm, even in patients without a history of CAD.1 148 249 Contraindicated in patients with ischemic or vasospastic heart disease.1 148 249
Contraindicated in patients with Wolff-Parkinson-White syndrome or cardiac arrhythmias associated with other accessory pathway conduction disorders.1
Tightness, pain, pressure, and heaviness in the precordium, throat, neck, and jaw occur frequently but usually are noncardiac in origin.1 148 249 Manufacturer states that cardiovascular evaluation should be performed if patient is at high cardiac risk.1
Patients with symptoms suggestive of angina after receiving sumatriptan should be evaluated for presence of CAD or predisposition to Prinzmetal variant angina before receiving additional doses;1 148 249 if administration resumed and such signs or symptoms recur, ECG evaluation recommended.148 249
Patients at Risk for CAD
Perform cardiovascular evaluation prior to initiating therapy in patients with multiple cardiovascular risk factors (e.g., postmenopausal women; men >40 years of age; patients with risk factors such as hypertension, hypercholesterolemia, smoking, obesity, diabetes, family history of CAD) who have not previously received 5-HT1 receptor agonist therapy.1 34 148 164 249
Other Vasospastic Effects
Possible noncoronary vasospastic reactions (e.g., peripheral vascular ischemia, GI ischemia and infarction with abdominal pain and bloody diarrhea, splenic infarction, Raynaud’s syndrome); transient or permanent blindness and partial vision loss reported very rarely in patients receiving 5-HT1 receptor agonists.1 148 249
Monitor BP in all patients receiving the drug.1
Potentially life-threatening serotonin syndrome reported in patients receiving 5-HT1 receptor agonists, particularly in those receiving SSRIs or SNRIs concomitantly.1 148 249 272 (See Specific Drugs under Interactions.) Also may occur in patients receiving MAO inhibitors or tricyclic antidepressants concomitantly.1
Symptoms may include mental status changes (e.g., agitation, hallucinations, coma), autonomic instability (e.g., tachycardia, labile BP, hyperthermia), neuromuscular aberrations (e.g., hyperreflexia, incoordination), and/or GI symptoms (e.g., nausea, vomiting, diarrhea).1 148 249 272
Medication Overuse Headache
Overuse of drugs indicated for management of acute migraine attacks (e.g., use of 5-HT1 receptor agonists, ergotamine, opiates, or certain analgesic combinations on a regular basis for ≥10 days per month) may result in migraine-like daily headaches or a marked increase in frequency of migraine attacks.1 148 249 276 277
Detoxification, including withdrawal of overused drugs; treatment of withdrawal symptoms (e.g., transient worsening of headaches); and consideration of prophylactic migraine therapy may be necessary.1 148 249 276 277
Possible transient irritation in nose and throat (e.g., burning, numbness, paresthesia, discharge, pain/soreness), sometimes severe, after intranasal administration; symptoms usually resolve in <2 hours.249 Effects of extended and repeated use on nasal and/or respiratory mucosa not systematically evaluated.249
Hypersensitivity reactions (e.g., anaphylaxis/anaphylactoid reactions), possibly life-threatening or fatal, reported rarely; increased risk in patients with history of sensitivity to multiple allergens.1 148 249
Use of Fixed Combinations
When used in fixed combination with naproxen, consider the cautions, precautions, and contraindications associated with naproxen.281
Distributed into human milk.14 40 148 242 249 279 280 283 Caution advised if sumatriptan is used.279 280 Expressing and discarding all milk for 8 hours after receiving a sub-Q dose may minimize exposure to the limited amount of drug distributed into milk.242 283 The manufacturers recommend avoiding breast-feeding for 12 hours after receiving sumatriptan oral tablets or nasal spray.148 249
Insufficient experience in patients ≥65 years of age to determine whether geriatric patients respond differently than younger adults.1
Due to important role of the liver in presystemic clearance of oral sumatriptan, dosage adjustment recommended if oral therapy is deemed advisable in patients with hepatic impairment.148 (See Hepatic Impairment under Dosage and Administration.)
Pharmacokinetics of sub-Q sumatriptan not substantially altered in patients with moderate hepatic impairment.1
Common Adverse Effects
With oral therapy, pain/pressure sensations in chest/neck/throat/jaw, paresthesia, warm or cold sensation, malaise/fatigue, vertigo.148
With intranasal therapy, taste disturbances, nausea, vomiting, disorder/discomfort of nasal cavity or sinuses.249
With sub-Q therapy, injection site reaction; atypical sensations (e.g., tingling, warm/hot sensation, burning, feeling of heaviness, pressure, tightness, numbness, paresthesia); dizziness/vertigo; flushing; discomfort of throat, jaw, sinuses, or nasal cavity; weakness, neck pain/stiffness, myalgia; drowsiness/sedation; headache; sweating; chest discomfort (tightness, pressure); nausea and vomiting.1
Interactions for Imitrex
Metabolized principally by MAO-A isoenzyme in vitro.148
Pretreatment with oral sumatriptan followed by acetaminophen affected rate, but not extent of acetaminophen absorption over 8 hours187
Antidepressants, SSRIs (e.g., citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline) and SNRIs (e.g., duloxetine, venlafaxine)
Observe carefully if used concomitantly, particularly during treatment initiation, dosage increases, or when another serotonergic agent is initiated272
Ergot alkaloids (e.g., ergotamine, dihydroergotamine, methysergide [no longer commercially available in the US])
Topical application of xylometazoline to nasal mucosa 15 minutes prior to intranasal sumatriptan did not affect sumatriptan pharmacokinetics249
Absorbed rapidly after oral, intranasal, or sub-Q administration, with peak plasma concentrations attained within approximately 0.5–5 hours, 0.8–1.8 hours, or 5–20 minutes, respectively.1 2 3 13 45 61 78 79 89 96 123 146 148 166 168 236 280
Bioavailability after sub-Q administration averages 97% of that obtained with IV administration;1 44 bioavailability after oral or intranasal administration averages only about 15 or 17%, respectively, principally due to presystemic metabolism and in part due to incomplete absorption.2 13 14 44 45 61 89 146 148 166 168 249
Oral absorption is not appreciably affected by gastric stasis that may occur during migraine attack,3 13 45 146 but time to peak concentration is prolonged by about 30 minutes;3 13 45 96 146 148 pharmacokinetics after sub-Q injection or after oral administration in fixed combination with naproxen sodium appear to be similar during migraine attacks and pain-free periods.1 281
Oral administration of sumatriptan 85 mg/naproxen sodium 500 mg (as fixed combination) or sumatriptan 100 mg alone resulted in similar peak concentrations and AUCs of sumatriptan; time to peak concentration was about 30 minutes shorter when administered as the fixed combination.281
Following sub-Q administration via needleless device at sites on the abdomen or thigh, peak concentrations and time to peak concentrations were similar; administration using this technique at sites on the upper arm may result in delivery of a suboptimal dose.280
In patients with hepatic impairment, bioavailability after oral administration may be markedly increased.148 In a small study, AUC and peak plasma concentrations increased approximately 70% and time to peak plasma concentrations occurred 40 minutes earlier after oral administration compared with such values in healthy adults.13 44 148 236
After oral administration, onset of relief of migraine symptoms generally occurs within 1–3 hours after single doses (25–100 mg),92 148 162 178 191 with maximum pain relief attained within 3–6 hours.148 178 191
After sub-Q administration, onset of pain relief usually occurs within 10–34 minutes in patients with moderate to severe migraine headache pain, with maximum relief attained within 1–2 hours;1 8 9 13 47 56 162 176 181 onset of pain relief generally occurs within 4–7 minutes in patients with cluster headache, with headache resolution shortly thereafter.40 49 75 184
Plasma Protein Binding
Metabolized in the liver and possibly in the GI tract principally to inactive indole acetic acid metabolite and other minor metabolites;1 2 3 13 14 104 148 166 metabolized principally by MAO-A isoenzyme in vitro.1 37 48 148
After oral administration, excreted in urine (57–60%) and feces (37–40%); only 3 and 9% of dose is excreted as unchanged drug in urine and feces, respectively.14 45 148 13 45 148 166 168 After sub-Q administration, approximately 22 or 38–53% of dose is excreted in urine unchanged or as indole acetic acid metabolite, respectively;1 45 168 0.6 and 3.3% of dose is excreted in feces as unchanged drug and indole acetic acid metabolite, respectively.2 13 14 45
2–30°C; protect from light.249
Cartridge, vial: 2–30°C; protect from light.1
Prefilled injection pen: 25°C (may be exposed to 15–30°C); protect from light; do not refrigerate.279
Prefilled needleless device: 20–25°C (may be exposed to 15–30°C); do not freeze.280
Precise mechanism of action not established;4 6 9 13 77 87 may ameliorate migraine and cluster headache through selective constriction of certain large cranial blood vessels and/or inhibition of neurogenic inflammatory processes in the CNS.1 2 3 6 7 9 10 13 47 66 73 77 88 110 119 131 177 184 186 217 236 237
Advice to Patients
Risk of serious cardiovascular or cerebrovascular events (e.g., MI, stroke) or other vasospastic reactions.1 148 249 Importance of seeking medical care if symptoms of such reactions (e.g., shortness of breath, weakness, slurring of speech, sudden or severe abdominal pain, difficulty in seeing, or tightness, pain, pressure, or heaviness in chest, throat, jaw, or neck) occur and of not taking sumatriptan again until evaluated by a clinician.1 148 249
Importance of contacting clinician immediately if symptoms suggestive of hypersensitivity (e.g., shortness of breath, wheezing, palpitations, rash, urticaria, swelling of mouth, tongue, or throat) occur.1 148 249
Importance of providing patient a copy of manufacturer’s patient information.1 148 249 Importance of clinician providing adequate instructions, as well as the written administration instructions supplied with the autoinjection device or nasal spray, before first use.1 171 249 279 280
Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs and herbal supplements, as well as any concomitant illnesses (e.g., cardiovascular disease).1 148 249
Importance of informing patients of risk of serotonin syndrome, particularly with concurrent use of sumatriptan and an SSRI, SNRI, MAO inhibitor, or tricyclic antidepressant.1 148 249 272 Importance of seeking immediate medical attention if symptoms of serotonin syndrome develop.1 148 249 272
Overuse of drugs indicated for the management of acute migraine attacks may exacerbate headaches; importance of recording headache frequency and drug use to monitor effectiveness of treatment.1 148 249 276
Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.
* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name
5 mg/0.1 mL*
Imitrex Nasal Spray
Sumatriptan Nasal Spray
20 mg/0.1 mL*
Imitrex Nasal Spray
Sumatriptan Nasal Spray
* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name
25 mg (of sumatriptan)*
Sumatriptan Succinate Tablets
50 mg (of sumatriptan)*
Sumatriptan Succinate Tablets
100 mg (of sumatriptan)*
Sumatriptan Succinate Tablets
Injection, for subcutaneous use only
4 mg (of sumatriptan) per 0.5 mL*
Imitrex (available in 0.5-mL unit-of-use injection-pen cartridges)
Sumatriptan Succinate Injection (available in 0.5-mL unit-of-use injection-pen cartridges)
6 mg (of sumatriptan) per 0.5 mL*
Alsuma (available in prefilled disposable single-use 0.5-mL injection pen)
Imitrex (available in 0.5-mL unit-of-use injection-pen cartridges and as 0.5-mL single-dose vials)
Sumatriptan Succinate Injection (available in 0.5-mL unit-of-use injection-pen cartridges and as 0.5-mL single-dose vials)
Sumavel (available in prefilled disposable single-use 0.5-mL needleless delivery device)
85 mg (of sumatriptan) with 500 mg Naproxen Sodium
This pricing information is subject to change at the sole discretion of DS Pharmacy. This pricing information was updated 02/2014. Actual costs to patients will vary depending on the use of specific retail or mail-order locations and health insurance copays.
Imitrex 100MG Tablets (GLAXO SMITH KLINE): 9/$255.00 or 27/$754.00
Imitrex 20MG/ACT Solution (GLAXO SMITH KLINE): 6/$270.98 or 18/$790.96
Imitrex 25MG Tablets (GLAXO SMITH KLINE): 9/$272.65 or 27/$791.50
Imitrex 5MG/ACT Solution (GLAXO SMITH KLINE): 1/$55.49 or 3/$136.30
Imitrex 50MG Tablets (GLAXO SMITH KLINE): 9/$268.99 or 27/$780.99
Imitrex STATdose Refill 6MG/0.5ML Solution (GLAXO SMITH KLINE): 1/$217.16 or 3/$603.25
Imitrex STATdose System 6MG/0.5ML Solution (GLAXO SMITH KLINE): 1/$217.16 or 3/$628.59
SUMAtriptan 20MG/ACT Solution (SANDOZ): 1/$45.99 or 3/$119.96
SUMAtriptan 5MG/ACT Solution (SANDOZ): 1/$45.99 or 3/$125.97
SUMAtriptan Succinate 100MG Tablets (SUN PHARMACEUTICAL): 9/$205.00 or 27/$583.98
SUMAtriptan Succinate 25MG Tablets (SUN PHARMACEUTICAL): 9/$219.99 or 27/$619.95
SUMAtriptan Succinate 50MG Tablets (RANBAXY PHARMACEUTICALS): 9/$199.99 or 27/$569.97
Sumavel DosePro 6MG/0.5ML Device (ZOGENIX): 1/$106.99 or 2/$304.97
Treximet 85-500MG Tablets (GLAXO SMITH KLINE): 9/$219.98 or 27/$629.97
AHFS DI Essentials. © Copyright, 2004-2014, Selected Revisions August 5, 2013. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.
1. GlaxoSmithKline. Imitrex (sumatriptan succinate) injection prescribing information. Research Triangle Park, NC; 2012 Oct.
2. Hsu VD. Sumatriptan: a new drug for vascular headache. Clin Pharm. 1992; 11:919-29. [IDIS 303852] [PubMed 1334452]
3. Bateman DN. Sumatriptan. Lancet. 1993; 341:221-4. [IDIS 308640] [PubMed 8093509]
4. Peroutka SJ. Serotonin receptor subtypes and neuropsychiatric diseases: focus on 5-HT1D and 5-HT3 receptor agents. Pharmacol Rev. 1991; 43:579-86. [IDIS 296518] [PubMed 1663621]
5. MacIntyre PD, Bhargava B, Hogg KJ et al. Effect of subcutaneous sumatriptan, a selective 5HT1 agonist, on the systemic, pulmonary, and coronary circulation. Circulation. 1993; 87:401-5. [IDIS 309421] [PubMed 8381056]
6. Fullerton T, Gengo FM. Sumatriptan: a selective 5-hydroxytryptamine receptor agonist for the acute treatment of migraine. Ann Pharmacother. 1992; 26:800-8. [IDIS 298261] [PubMed 1319244]
7. Anon. Sumatriptan for migraine. Med Lett Drugs Ther. 1992; 34:91-3. [PubMed 1326077]
8. Ferrari MD and the Subcutaneous Sumatriptan International Study Group. Treatment of migraine attacks with sumatriptan. N Engl J Med. 1991; 325:316-21. [IDIS 283296] [PubMed 1647495]
9. Cady RK, Wendt JK, Kirchner JR et al. Treatment of acute migraine with subcutaneous sumatriptan. JAMA. 1991; 265:2831-5. [IDIS 281579] [PubMed 1851894]
10. Friberg L, Olesen J, Iversen HK et al. Migraine pain associated with middle cerebral artery dilatation: reversal by sumatriptan. Lancet. 1991; 338:13-7. [IDIS 282832] [PubMed 1676084]
11. Fox AW, Poe TE. Use and safety of sumatriptan. Clin Pharm. 1993; 12:258. [IDIS 311529] [PubMed 8384541]
12. Glaxo, Research Triangle Park, NC: Personal communication.
13. Plosker GL, McTavish D. Sumatriptan: a reappraisal of its pharmacology and therapeutic efficacy in the acute treatment of migraine and cluster headache. Drugs. 1994; 47:622-51. [PubMed 7516861]
14. Dixon CM, Saynor DA, Andrew PD et al. Disposition of sumatriptan in laboratory animals and humans. Drug Metabol Disp. 1993; 21:761-9.
15. Dechant KL, Clissold SP. Sumatriptan: a review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy in the acute treatment of migraine and cluster headache. Drugs. 1992; 43:776-98. [PubMed 1379152]
16. D’Arcy PF. Adverse drug reaction (ADR) problems with sumatriptan. Intl Pharm J. 1992; 6:264-5.
17. D’Arcy PF. Warnings from the UK committee on safety of medicines: chest pain with sumatriptan. Intl Pharm J. 1992; 6:217-8.
18. Willett F, Curzen N, Adams J et al. Coronary vasospasm induced by subcutaneous sumatriptan. BMJ. 1992; 304:1415. [IDIS 297248] [PubMed 1320974]
19. Price LH, Charney DS, Delgado PL et al. Lithium treatment and serotoninergic function. Arch Gen Psych. 1989; 46:13-9.
20. Castle WM, Simmons VE. Coronary vasospasm and sumatriptan. BMJ. 1992; 305:117-8. [IDIS 299098] [PubMed 1322216]
21. Stricker BHC. Coronary vasospasm and sumatriptan. BMJ. 1992; 305:118.
22. Inman W, Kubota K. Cardiorespiratory distress after sumatriptan given by injection. BMJ. 1992; 305:714. [IDIS 302441] [PubMed 1327369]
23. Curtin T, Brooks AP, Roberts JA. Cardiorespiratory distress after sumatriptan given by injection. BMJ. 1992; 305:713-4. [IDIS 302439] [PubMed 1327368]
24. Pilgrim AJ, Lloyd DK, Simmons VE. Cardiorespiratory distress after sumatriptan given by injection. Br Med J. 1992;305:714. Letter. (IDIS 302439)
25. Lloyd DK, Pilgrim AJ, Simmons VE. Coronary vasospasm and sumatriptan. BMJ. 1992; 305:310-1. [IDIS 300103] [PubMed 1327366]
26. Anon. New medicines: sumatriptan. Intl Pharm J. 1992; 6:55-7.
27. Ottervanger JP, Paalman HJA, Boxma GL et al. Transmural myocardial infarction with sumatriptan. Lancet. 1993; 341:861-2. [IDIS 312131] [PubMed 8096565]
28. Hillis WS, Macintyre PD. Sumatriptan and chest pain. Lancet. 1993; 342:683. [IDIS 320009] [PubMed 8103169]
29. Hillis WS, MacIntyre PD. Sumatriptan and chest pain. Lancet. 1993; 341:1564-5. [IDIS 316435] [PubMed 8099643]
30. Ottervanger JP, Stricker BHC. Sumatriptan and chest pain. Lancet. 1993; 342:176.
31. Chester AH, O’Neil GS, Yacoub MH. Sumatriptan and ischaemic heart disease. Lancet. 1993; 341:1419-20. [IDIS 315064] [PubMed 8098831]
32. Bax WA, Saxena PR. Sumatriptan and ischaemic heart disease. Lancet. 1993; 341:1420. [IDIS 315065] [PubMed 8098832]
33. Myerburg RJ, Kessler KM, Mallon SM et al. Life-threatening ventricular arrhythmias in patients with silent myocardial ischemia due to coronary artery spasm. N Engl J Med. 1992; 326:1451-5. [IDIS 296579] [PubMed 1574091]
34. MacLean MR, Smith GCS, Templeton AGB. Adverse reactions associated with sumatriptan. Lancet. 1993; 341:1092.
35. Lloyd DK, Simmons V. Adverse reactions associated with sumatriptan. Lancet. 1993; 341:1092. [IDIS 313075] [PubMed 8096981]
36. Cavazos JE, Caress JB, Chilukuri VR et al. Sumatriptan-induced stroke in sagittal sinus thrombosis. Lancet. 1994; 343:1105-6. [IDIS 330002] [PubMed 7909130]
37. Cerenex Pharmaceuticals, Div. of Glaxo, Inc., Research Triangle Park, NC: Personal communication.
38. Humphrey PPA, Feniuk W. Mode of action of the anti-migraine drug sumatriptan. Trends Pharmacol Sci. 1991; 12:444-6. [PubMed 1665260]
39. Lovenberg TW, Erlander MG, Baron BM et al. Molecular cloning and functional expression of 5-HT1E-like rat and human 5-hydroxytryptamine receptor genes. Proc Natl Acad Sci USA. 1993; 90:2184-8. [PubMed 8384716]
40. Cerenex Pharmaceuticals, Div. of Glaxo, Inc., Research Triangle Park, NC: Personal communication.
41. Sullivan JT, Preston KL, Testa MP et al. Psychoactivity and abuse potential of sumatriptan. Clin Pharmacol Ther. 1992; 52:635-42. [IDIS 307784] [PubMed 1333934]
42. Luman W, Gray RS. Adverse reactions associated with sumatriptan. Lancet. 1993; 341:1091-2. [IDIS 313073] [PubMed 8096980]
43. Caekebeke JFV, Ferrari MD, Zwetsloot CP et al. Antimigraine drug sumatriptan increases blood flow velocity in large cerebral arteries during migraine attacks. Neurology. 1992; 42:1522-6. [IDIS 300080] [PubMed 1322512]
44. Lacey LF, Fowler PA. The clinical pharmacology of sumatriptan. Cephalalgia. 1993; 13(Suppl 13):156.
45. Fowler PA, Lacey LF, Thomas M et al. The clinical pharmacology, pharmacokinetics, and metabolism of sumatriptan. Eur Neurol. 1991; 31:291-4. [PubMed 1653135]
46. Dahlof C. Headache recurrence after subcutaneous sumatriptan and early treatment. Lancet. 1992; 340:909. [IDIS 303758] [PubMed 1357313]
47. Ferrari MD, Saxena PR. Clinical and experimental effects of sumatriptan in humans. Trends Pharmacol Sci. 1993; 14:129-33. [PubMed 8390743]
48. Anon. Sumatriptan: a new approach to migraine. Drug Ther Bull. 1992; 30:85-7. [PubMed 1330474]
49. The Sumatriptan Cluster Headache Study Group. Treatment of acute cluster headache with sumatriptan. N Engl J Med. 1991; 325:322-6. [IDIS 283297] [PubMed 1647496]
50. Lloyd DK, Pilgrim AJ. Sumatriptan and recurrence of migraine. Lancet. 1992; 340:1110. [IDIS 304617] [PubMed 1357515]
51. Blau JN. Sumatriptan and recurrence of migraine. Lancet. 1992; 340:1110. [IDIS 304618] [PubMed 1357514]
52. Black P, Caldwell J. Skin sensitivity to sumatriptan. N Z Med J. 1994; 107:20- 1. [IDIS 325657] [PubMed 8295755]
53. Sykes RS, Castle W, Palmer J. Sumatriptan-induced stroke in sagittal sinus thrombosis. Lancet. 1994; 343:1299-300. [IDIS 330600] [PubMed 7910310]
54. Carp H, Singh PJ, Vadhera R et al. Effects of the serotonin-receptor agonist sumatriptan on postdural puncture headache: report of six cases. Anesth Analg. 1994; 79:180-2. [IDIS 332633] [PubMed 8010433]
55. Solbach MP, Waymer RS. Treatment of menstruation-associated migraine headache with subcutaneous sumatriptan. Obstet Gynecol. 1993; 82:769-72. [IDIS 321578] [PubMed 8414324]
56. Cady RK, Dexter J, Sargent JD et al. Efficacy of subcutaneous sumatriptan in repeated episodes of migraine. Neurology. 1993; 43:1363-8. [IDIS 317183] [PubMed 8392150]
57. Thomson AN, Arthur GP, Bergin PS et al. Subcutaneous sumatriptan in acute treatment of migraine: a multicentre New Zealand trial. N Z Med J. 1993; 106:171-3. [IDIS 316753] [PubMed 8389026]
58. Bousser MG, d’Allens H, Richard A et al. Efficacy of subcutaneous sumatriptan in the acute treatment of early-morning migraine: a placebo-controlled trial. J Int Med. 1993; 234:211-6.
59. Goadsby PJ, Zagami AS, Donnan GA et al. Oral sumatriptan in acute migraine. Lancet. 1991; 338:782-3. [IDIS 286705] [PubMed 1681162]
60. Tfelt-Hansen P, Sperling B, Winter PDO’B. Transient additional effect of sumatriptan on ergotamine-induced constriction of peripheral arteries in man. Clin Pharmacol Ther. 1992; 51:149.
61. Posner JB. Disorders of sensation: headache and other pain. In: Wyngaarden JB, Smith LH Jr, Bennett JC, eds. Cecil textbook of medicine. 19th ed. Philadelphia: WB Saunders Company; 1992:2116-24.
62. Scott AK, Walley T, Breckenridge AM et al. Lack of an interaction between propranolol and sumatriptan. Br J Clin Pharmacol. 1991; 32:581-4. [IDIS 294713] [PubMed 1659437]
63. Kaube H, May A, Diener HC et al. Sumatriptan. BMJ. 1994; 308:1573-4.
64. Osborne MJ, Austin RCT, Dawson KJ et al. Is there a problem with long term use of sumatriptan in acute migraine? Br Med J. 1994; 308:113. (IDIS 325298)
65. den Boer MO, Somers JAE, Saxena PR. Lack of effect of the antimigraine drugs, sumatriptan, ergotamine and dihydroergotamine on arteriovenous anastomotic shunting in the dura mater of the pig. Br J Pharmacol. 1992; 107:577-83. [PubMed 1330188]
66. Feniuk W, Humphrey PPA, Perren MJ. The selective carotid arterial vasoconstrictor action of GR43175 in anaesthetized dogs. Br J Pharmacol. 1989; 96:83-90. [PubMed 2538184]
67. Kaube H, Hoskin KL, Goadsby PJ. Inhibition by sumatriptan of central trigeminal neurones only after blood-brain barrier disruption. Br J Pharmacol. 1993; 109:788-92. [PubMed 8395298]
68. den Boer MO, Villalón CM, Heiligers JPC et al. Role of 5-HT1-like receptors in the reduction of porcine cranial arteriovenous anastomotic shunting by sumatriptan. Br J Pharmacol. 1991; 102:323-30. [PubMed 1849764]
69. Bax WA, Renzenbrink GJ, Van Heuven-Nolsen D et al. 5-HT receptors mediating contractions of the isolated human coronary artery. Eur J Pharmacol. 1993; 239:203-10. [PubMed 7693489]
70. Perren MJ, Feniuk W, Humphrey PPA. The selective closure of feline carotid arteriovenous anastomoses (AVAs) by GR43175. Cephalalgia. 1989; 9(Suppl 9):41-6. [PubMed 2544282]
71. Goadsby PJ, Edvinsson L. The trigeminovascular system and migraine: studies characterizing cerebrovascular and neuropeptide changes seen in humans and cats. Ann Neurol. 1993; 33:48-56. [PubMed 8388188]
72. Mathew NT, Dexter J, Couch J et al. Dose ranging efficacy and safety of subcutaneous sumatriptan in the acute treatment of migraine. Arch Neurol. 1992; 49:1271-6. [PubMed 1333181]
73. Jansen I, Olesen J, Edvinsson L. 5-Hydroxytryptamine receptor characterization of human cerebral, middle meningeal and temporal arteries: regional differences. Acta Physiol Scand. 1993; 147:141-50. [PubMed 8386424]
74. Nozaki K, Moskowitz MA, Boccalini P. CP-93,129, sumatriptan, dihydroergotamine block c-fos expression within rat trigeminal nucleus caudalis caused by chemical stimulation of the meninges. Br J Pharmacol. 1992; 106:409-15. [PubMed 1327382]
75. Ekbom K, Monstad I, Prusinski A et al. Subcutaneous sumatriptan in the acute treatment of cluster headache: a dose comparison study. Acta Neurol Scand. 1993; 88:63-9. [PubMed 8396833]
76. Houghton LA, Fowler P, Keene ON et al. Effect of sumatriptan, a new selective 5HT1-like agonist, on liquid gastric emptying in man. Aliment Pharmacol Ther. 1992; 6:685-91. [PubMed 1336675]
77. Humphrey PPA, Feniuk W, Perren MJ et al. The pharmacology of the novel 5- HT1-like receptor agonist, GR43175. Cephalalgia. 1989; 9(Suppl 9):23-33. [PubMed 2544280]
78. Gutterman DL, Plachetka JR, Donn K et al. Evaluation of the safety and pharmacokinetic properties of single subcutaneous doses of GR43175C in healthy, adult, male volunteers. Cephalalgia. 1989; 9(Suppl 10):412-3.
79. Busch MA, Plachetka JR, Donn KH. Evaluation of the pharmacokinetics and safety of ascending single oral doses of GR43175 administered to healthy male volunteers. Cephalalgia. 1989; 9(Suppl 10):414-5.
80. Italian Society for the Study of Headache. Guidelines and recommendations for the treatment of migraine. Funct Neurol. 1993; 8:441-6. [PubMed 8150324]
81. Muly EC, McDonald W, Steffens D et al. Serotonin syndrome produced by a combination of fluoxetine and lithium. Am J Psychiatry. 1993; 150:1565. [IDIS 321772] [PubMed 8379573]
82. Tansey MJB, Pilgrim AJ, Martin PM. Long-term experience with sumatriptan in the treatment of migraine. Eur Neurol. 1993; 33:310-5. [PubMed 8394239]
83. Peroutka SJ, McCarthy BG. Sumatriptan (GR43175) interacts selectively with 5- HT1B and 5-HT1D binding sites. Eur J Pharmacol. 1989; 163:133-6. [PubMed 2545459]
84. The Oral Sumatriptan and Aspirin plus Metoclopramide Comparative Study Group. A study to compare oral sumatriptan with oral aspirin plus oral metoclopramide in the acute treatment of migraine. Eur Neurol. 1992; 32:177-84. [PubMed 1317294]
85. Chester AH, Martin GR, Bodelsson M et al. 5-Hydroxytryptamine receptor profile in healthy and diseased human epicardial coronary arteries. Cardiovasc Res. 1990; 24:932-7. [PubMed 2272071]
86. Sumner MJ, Humphrey PPA. Sumatriptan (GR43175) inhibits cyclic-AMP accumulation in dog isolated saphenous vein. Br J Pharmacol. 1990; 99:219-20. [PubMed 2158369]
87. Humphrey PPA, Feniuk W, Perren MJ et al. Serotonin and migraine. Ann NY Acad Sci. 1990; 600:587-98. [PubMed 2252337]
88. Parsons AA, Whalley ET. Characterization of the 5-hydroxytryptamine receptor which mediates contraction of the human isolated basilar artery. Cephalalgia. 1989; 9(Suppl 9):47-51. [PubMed 2544283]
89. Fowler PA, Thomas M, Lacey LF et al. Early studies with the novel 5-HT1-like agonist GR43175 in healthy volunteers. Cephalalgia. 1989; 9(Suppl 9):57-62. [PubMed 2544285]
90. Perrin VL, Färkkilä M, Goasguen J et al. Overview of initial clinical studies with intravenous and oral GR43175 in acute migraine. Cephalalgia. 1989; 9(Suppl 9):63- 72. [PubMed 2544286]
91. Tfelt-Hansen P, Brand J, Dano P et al. Early clinical experience with subcutaneous GR43175 in acute migraine: an overview. Cephalalgia. 1989; 9(Suppl 9):73-7. [PubMed 2544287]
92. The Oral Sumatriptan International Multiple-Dose Study Group. Evaluation of a multiple-dose regimen of oral sumatriptan for the acute treatment of migraine. Eur Neurol. 1991; 31:306-13. [PubMed 1653138]
93. The Sumatriptan Auto-Injector Study Group. Self-treatment of acute migraine with subcutaneous sumatriptan using an auto-injector device. Eur Neurol. 1991; 31:323-31. [PubMed 1653140]
94. Brown EG, Endersby CA, Smith RN et al. The safety and tolerability of sumatriptan: an overview. Eur Neurol. 1991; 31:339-44. [PubMed 1653142]
95. Moskowitz MA, Macfarlane R. Neurovascular and molecular mechanisms in migraine headaches. Cerebrovasc Brain Metab Rev. 1993; 5:159-77. [PubMed 8217498]
96. Cutler NR, Hussey EK, Sramek JJ et al. Pharmacokinetics (PK) of oral sumatriptan in migraine patients during an attack and while painfree. Biol Psych. 1992; 31:180A.
97. Facchinetti F, Nappi RE, Sances G et al. The neuroendocrine effects of sumatriptan, a specific ligand for 5-HT1-like receptors. Clin Endocrinol. 1994; 40:211-4.
98. McCarthy BG, Peroutka SJ. Comparative neuropharmacology of dihydroergotamine and sumatriptan (GR43175). Headache. 1989; 29:420-2. [PubMed 2547733]
99. Galer BS, Lipton RB, Solomon S et al. Myocardial ischemia related to ergot alkaloids: a case report and literature review. Headache. 1991; 31:446-50. [PubMed 1774159]
100. Panconesi A, Anselmi B, Curradi C et al. Comparison between venoconstrictor effects of sumatriptan and ergotamine in migraine patients. Headache. 1994; 34:194-7. [PubMed 8014033]
101. Peroutka SJ, Havlik S, Oksenberg D. Wolff award presentation 1993. Anti-migraine drug interactions with cloned human 5-hydroxytryptaminel receptor subtypes. Headache. 1993; 33:347-50. [PubMed 8397171]
102. Connor HE, Feniuk W, Humphrey PPA. 5-Hydroxytryptamine contracts human coronary arteries predominantly via 5-HT2 receptor activation. Eur J Pharmacol. 1989; 161:91-4. [PubMed 2542039]
103. Goadsby PJ, Edvinsson L. Human in vivo evidence for trigeminovascular activation in cluster headache: neuropeptide changes and effects of acute attacks therapies. Brain. 1994; 117:427-34. [PubMed 7518321]
104. Dixon CM, Park GR, Tarbit MH. Characterization of the enzyme responsible for the metabolism of sumatriptan in human liver. Biochem Pharmacol. 1994; 47:1253-7. [PubMed 8161354]
105. Humphrey PPA, Feniuk W, Perren MJ et al. GR43175, a selective agonist for the 5- HT1-like receptor in dog isolated saphenous vein. Br J Pharmacol. 1988; 94:1123- 32. [PubMed 2850055]
106. Rebeck GW, Maynard KI, Hyman BT et al. Selective 5-HT1D α serotonin receptor gene expression in trigeminal ganglia: implications for antimigraine drug development. Proc Natl Acad Sci USA. 1994; 91:3666-9. [PubMed 8170966]
107. Totaro R, De Matteis G, Marini C et al. Effect of sumatriptan on cerebral blood flow velocity measured by transcranial doppler. Stroke. 1993; 24:516.
108. Nappi G, Sicuteri F, Byrne M et al. Oral sumatriptan compared with placebo in the acute treatment of migraine. J Neurol. 1994; 241:138-44. [PubMed 8164015]
109. Ebersole BJ, Diglio CA, Kaufman DW et al. 5-Hydroxytryptamine1-like receptors linked to increases in intracellular calcium concentration and inhibition of cyclic AMP accumulation in cultured vascular smooth muscle cells derived from bovine basilar artery. J Pharmacol Exp Ther. 1993; 266:692-9. [PubMed 8394913]
110. Den Boer MO, Villalón CM, Saxena PR. 5-HT1-like receptor mediated changes in porcine carotid haemodynamics: are 5-HT1D receptors involved? Arch Pharmacol. 1992; 345:509-15.
111. Ensink FBM for the Sumatriptan International Study Group. Subcutaneous sumatriptan in the acute treatment of migraine. J Neurol. 1991; 238(Suppl 1):S66-9.
112. Wayne VS. A possible relationship between migraine and coronary artery spasm. Aust N Z J Med. 1986; 16:708-10. [PubMed 3469972]
113. Saper JR. Ergotamine dependency: a review. Headache. 1987; 27:435-8. [PubMed 3117735]
114. Lloyd DK, Arnold WSG. Long term use of sumatriptan. BMJ. 1994; 308:533.
115. Miller D, Waters DD, Warnica W et al. Is variant angina the coronary manifestation of a generalized vasospastic disorder? N Engl J Med. 1981; 304:763-6.
116. Leviton A, Malvea B, Graham JR. Vascular diseases, mortality, and migraine in the parents of migraine patients. Neurology. 1974; 24:669-72. [PubMed 4858091]
117. Moskowitz MA, Buzzi MG. Neuroeffector functions of sensory fibres: implications for headache mechanisms and drug actions. J Neurol. 1991; 238(Suppl 1):S18-22. [PubMed 2045826]
118. Saxena PR, Den Boer MO. Pharmacology of antimigraine drugs. J Neurol. 1991; 238(Suppl 1):S28-35. [PubMed 1646288]
119. Feniuk W, Humphrey PPA, Perren MJ et al. Rationale for the use of 5-HT1- like agonists in the treatment of migraine. J Neurol. 1991; 238(Suppl 1):S57-61. [PubMed 1646289]
120. Bax WA, Van Heuven-Nolsen D, Bos E et al. 5-hydroxytryptamine-induced contractions of the human isolated saphenous vein: involvement of 5-HT2 and 5- HT1D-like receptors, and a comparison with grafted veins. Arch Pharmacol. 1992; 345:500-8.
121. Buzzi MG, Carter WB, Shimizu T et al. Dihydroergotamine and sumatriptan attenuate levels of CGRP in plasma in rat superior sagittal sinus during electrical stimulation of the trigeminal ganglion. Neuropharmacology. 1991; 30:1193-200. [PubMed 1663596]
122. Franceschini R, Cataldi A, Garibaldi A et al. The effects of sumatriptan on pituitary secretion in man. Neuropharmacology. 1994; 33:235-9. [PubMed 8035909]
123. The Finnish Sumatriptan Group and the Cardiovascular Clinical Research Group. A placebo-controlled study of intranasal sumatriptan for the acute treatment of migraine. Eur Neurol. 1991; 31:332-8. [PubMed 1653141]
124. The Multinational Oral Sumatriptan and Cafergot Comparative Study Group. A randomized, double-blind comparison of sumatriptan and cafergot in the acute treatment of migraine. Eur Neurol. 1991; 31:314-22. [PubMed 1653139]
125. Buzzi MG, Dimitriadou V, Theoharides TC et al. 5-Hydroxytryptamine receptor agonists for the abortive treatment of vascular headaches block mast cell, endothelial and platelet activation within the rat dura mater after trigeminal stimulation. Brain Res. 1992; 583:137-49. [PubMed 1324091]
126. Bruinvels AT, Lery H, Nozulak J et al. 5-HT1D binding sites in various species: similar pharmacological profile in dog, monkey, calf, guinea-pig and human brain membranes. Arch Pharmacol. 1992; 346:243-8.
127. De Keyser J, Vauquelin G, De Backer JP et al. What intracranial tissues in humans contain sumatriptan-sensitive serotonin 5-HT1-type receptors? Neurosci Lett. 1993; 164:63-6.
128. Waeber C, Hoyer D, Palacios JM. GR43175: a preferential 5-HT1D agent in monkey and human brains as shown by autoradiography. Synapse. 1989; 4:168-70. [PubMed 2551055]
129. Bruinvels AT, Landwehrmeyer B, Probst A et al. A comparative autoradiographic study of 5-HT1D binding sites in human and guinea-pig brain using different radioligands. Molecul Brain Res. 1994; 21:19-29.
130. Cocks TM, Kemp BK, Pruneau D et al. Comparison of contractile responses to 5- hydroxytryptamine and sumatriptan in human isolated coronary artery: synergy with the thromboxane A2-receptor agonist, U46619. Br J Pharmacol. 1993; 110:360-8. [PubMed 8220898]
131. Edvinsson L, Jansen I, Olesen J. Characterization of human craniovascular 5- hydroxytryptamine receptors. Front Headache Res. 1992; 2:129-36.
132. Beer MS, Stanton JA, Bevan Y et al. L-694,247: a potent 5-HT1D receptor agonist. Br J Pharmacol. 1993; 110:1196-200. [PubMed 8298808]
133. Huang Z, Byun B, Matsubara T et al. Time-dependent blockade of neurogenic plasma extravasation in dura mater by 5-HT1B/D agonists and endopeptidase 24.11. Br J Pharmacol. 1993; 108:331-5. [PubMed 8383561]
134. Brennum J, Kjeldsen M, Olesen J. The 5-HT1-like agonist sumatriptan has a significant effect in chronic tension-type headache. Cephalalgia. 1992; 12:375-9. [PubMed 1335361]
135. Hamblin MW, Metcalf MA, McGuffin RW et al. Molecular cloning and functional characterization of a human 5-HT1B serotonin receptor: a homologue of the rat 5- HT1B receptor with 5-HT1D-like pharmacological specificity. Biochem Biophys Res Comm. 1992; 184:752-9. [PubMed 1315531]
136. Sleight AJ, Cervenka A, Peroutka SJ. In vivo effects of sumatriptan (GR 43175) on extracellular levels of 5-HT in the guinea pig. Neuropharmacology. 1990; 29:511-3. [PubMed 2166920]
137. Adham N, Kao HT, Schechter LE et al. Cloning of another human serotonin receptor (5-HT1F): a fifth 5-HT1 receptor subtype coupled to the inhibition of adenylate cyclase. Proc Natl Acad Sci USA. 1993; 90:408-12. [PubMed 8380639]
138. Connor HE, Stubbs CM, Feniuk W et al. Effect of sumatriptan, a selective 5- HT1-like receptor agonist, on pial vessel diameter in anaesthetised cats. J Cerebral Blood Flow Metabol. 1992; 12:514-9.
139. Maura G, Thellung S, Andrioli GC et al. Release-regulating serotonin 5-HT1D autoreceptors in human cerebral cortex. J Neurochem. 1993; 60:1179-82. [PubMed 8382263]
140. Diener HC, Haab J, Peters C et al. Subcutaneous sumatriptan in the treatment of headache during withdrawal from drug-induced headache. Headache. 1991; 31:205-9. [PubMed 1646775]
141. Mills KC. Serotonin syndrome. Am Fam Physician. 1995; 52:1474-82.
142. Henry P, d’Allens H, French Migraine Network Bordeaux-Lyon-Grenoble. Subcutaneous sumatriptan in the acute treatment of migraine in patients using dihydroergotamine as prophylaxis. Headache. 1993; 33:432-5. [PubMed 8262783]
143. Schoenen J, Bulcke J, Caekebeke J et al. Self-treatment of acute migraine with subcutaneous sumatriptan using an auto-injector device: comparison with customary treatment in an open, longitudinal study. Cephalalgia. 1994; 14:55-63. [PubMed 8200027]
144. Lloyd DK, Pilgrim AJ. The safety of sumatriptan in asthmatic migraineurs. Cephalalgia. 1993; 13:201-4. [PubMed 8395345]
145. Banerjee M, Findley LJ. Sumatriptan in the treatment of acute migraine with aura. Cephalalgia. 1992; 12:39-44. [PubMed 1313746]
146. Scott AK. Sumatriptan: clinical pharmacokinetics. Clin Pharmacokinet. 1994; 27:337-44. [PubMed 7851052]
147. Bärtsch P, Maggi S, Kleger GR et al. Sumatriptan for high altitude headache. Lancet. 1994; 344:1445. [IDIS 338591] [PubMed 7968111]
148. GlaxoSmithKline. Imitrex (sumatriptan succinate) tablets prescribing information. Research Triangle Park, NC; 2012 Mar.
149. Chiari M, Manzoni GC, van de Geijn EJ. Ischemic optic neuropathy after sumatriptan in a migraine with aura patient. Headache. 1994; 34:237-8. [PubMed 8014044]
150. Palmer J, Feldman R, Mancini GB et al. Glyceryl trinitrate reversal of post- sumatriptan coronary artery narrowing. Lancet. 1995; 345:1366. [IDIS 348711] [PubMed 7752771]
151. Szabo CP. Fluoxetine and sumatriptan: possibly a counterproductive combination. J Clin Psychiatry. 1995; 56:37-8. [IDIS 342757] [PubMed 7836342]
152. Jayamaha JEL, Street MK. Fatal cerebellar infarction in a migraine sufferer whilst receiving sumatriptan. Intensive Care Med. 1995; 21:82-3. [IDIS 341704] [PubMed 7560482]
153. La Porta LD. Recurrent depression after sumatriptan administration for treatment of migraine. J Clin Psychopharmacol. 1995; 15:81-2. [IDIS 341600] [PubMed 7714232]
154. Anon. Sumatriptan: rebound headache and migraine exacerbation. CMAJ. 1995; 152:66.
155. Evers S, Husstedt IW, Enbergs A. Coronary angiography in migraine patient after subcutaneous sumatriptan. Lancet. 1995; 345:198. [IDIS 341082] [PubMed 7823698]
156. Garcia G, Kaufman MB, Colucci RD. Dystonic reaction associated with sumatriptan. Ann Pharmacother. 1994; 28:1199. [IDIS 337083] [PubMed 7841582]
157. Shane R. Development and implementation of practice guidelines (part 1). Hosp Formul. 1994; 29:711-9. [IDIS 336987] [PubMed 10137848]
158. Bates D, Ashford E, Dawson R et al. Subcutaneous sumatriptan during the migraine aura. Neurology. 1994; 44:1587-92. [IDIS 335543] [PubMed 7936279]
159. Houghton LA, Foster JM, Whorwell PJ et al. Is chest pain after sumatriptan oesophageal in origin? Lancet. 1994; 344:985-6.
160. Hood S, Birnie D, MacIntyre PD et al. Sumatriptan-induced chest pain. Lancet. 1994; 344:1500-1. [IDIS 339304] [PubMed 7832891]
161. Entwisle SJ, Fowler PA, Thomas M et al. The effects of oral sumatriptan, a 5- HT1 receptor agonist, on circulating ACTH and cortisol concentrations in man. Br J Clin Pharmacol. 1995; 39:389-95. [IDIS 345219] [PubMed 7640145]
162. Akpunonu BE, Mutgi AB, Federman DJ et al. Subcutaneous sumatriptan for treatment of acute migraine in patients admitted to the emergency department: a multicenter study. Ann Emerg Med. 1995; 25:464-9. [IDIS 345053] [PubMed 7710149]
163. Boyd IW, Rohan AP. Sumatriptan-induced chest pain. Lancet. 1994; 344:1704-5. [IDIS 339816] [PubMed 7996981]
164. Bhanji NH. Sumatriptan and chest pain. Can J Hosp Pharm. 1994; 47:232-4.
165. Gaist D, Sindrup S, Hallas J et al. Misuse of sumatriptan. Lancet. 1994; 344:1090. [IDIS 337456] [PubMed 7934471]
166. Warner PE, Brouwer KLR, Hussey EK et al. Sumatriptan absorption from different regions of the human gastrointestinal tract. Pharm Res. 1995; 12:138-43. [PubMed 7724476]
167. Anon. Drugs for migraine. Med Lett Drugs Ther. 1995; 37:17-20. [PubMed 7862023]
168. Lacey LF, Hussey EK, Fowler PA. Single dose pharmacokinetics of sumatriptan in healthy volunteers. Eur J Clin Pharmacol. 1995; 47:543-8. [IDIS 345294] [PubMed 7768259]
169. Ferrari MD, Haan J, Blokland AK et al. Cerebral blood flow during migraine attacks without aura and effect of sumatriptan. Arch Neurol. 1995; 52:135-9. [PubMed 7848120]
170. Pini LA, Trenti T. Does chronic use of sumatriptan induce dependence? Headache. 1994; 34:600.
171. Gross MLP, Kay J, Turner AM et al. Sumatriptan in acute migraine using a novel cartridge system self-injector. Headache. 1994; 34:559-63. [PubMed 7843948]
172. Catarci T, Fiacco F, Argentino C et al. Ergotamine-induced headache can be sustained by sumatriptan daily intake. Cephalalgia. 1994; 14:374-5. [PubMed 7828198]
173. Ferrari MD, James MH, Bates D et al. Oral sumatriptan: effect of a second dose, and incidence and treatment of headache recurrences. Cephalalgia. 1994; 14:330-8. [PubMed 7828190]
174. Russell MB, Holm-Thomsen OE, Nielsen MR et al. A randomized double-blind placebo-controlled crossover study of subcutaneous sumatriptan in general practice. Cephalalgia. 1994; 14:291-6. [PubMed 7954759]
175. Doenicke A, Melchart D, Bayliss EM. Effective improvement of symptoms in patients with acute migraine by GR43175 administered in dispersible tablets. Cephalalgia. 1989; 9(Suppl 9):89-92. [PubMed 2544290]
176. Ferrari MD, Saxena PRS. Clinical effects and mechanism of action of sumatriptan in migraine. Clin Neurol Neurosurg. 1992; 94(Suppl):S73-7.
177. Hoyer D, Clarke DE, Fozard JR et al. International union of pharmacology classification of receptors for 5-hydroxytryptamine (serotonin). Pharmacol Rev. 1994; 46:157-203. [PubMed 7938165]
178. Tansey MJB, Pilgrim AJ, Lloyd K. Sumatriptan in the acute treatment of migraine. J Neurol Sci. 1993; 114:109-16. [PubMed 8381852]
179. MacDonald JT. Treatment of juvenile migraine with subcutaneous sumatriptan. Headache. 1994; 34:581-2. [PubMed 7843952]
180. The Oral Sumatriptan Dose-Defining Study Group. Sumatriptan—an oral dose- defining study. Eur Neurol. 1991; 31:300-5. [PubMed 1653137]
181. Cady RK, Rubino J, Crummett D et al. Oral sumatriptan in the treatment of recurrent headache. Arch Fam Med. 1994; 3:766-72. [PubMed 7987510]
182. Suchowersky O. Rebound headaches due to sumatriptan. Neurology. 1993; 43(Suppl 2):A326.
183. Ekbom K, Krabbe A, Micelli G et al et al. Cluster headache attacks treated for up to three months with subcutaneous sumatriptan (6 mg). Cephalalgia. 1995; 15:230-6. [PubMed 7553814]
184. Hardebo JE. Subcutaneous sumatriptan in cluster headache: a time study of the effect on pain and autonomic symptoms. Headache. 1993; 33:18-21. [PubMed 8382200]
185. Monstad I, Krabbe A, Micieli G et al. Preemptive oral treatment with sumatriptan during a cluster period. Headache. 1995; 35:607-13. [PubMed 8550362]
186. Fanciullacci M, Alessandri M, Figini M et al. Increase in plasma calcitonin gene- related peptide from the extracerebral circulation during nitroglycerin-induced cluster headache attack. Pain. 1995; 60:119-23. [PubMed 7540279]
187. Rani PU, Naidu MUR, Rao TRK et al. Sumatriptan delays paracetamol absorption in migraine patients. Clin Drug Invest. 1996; 11:300-4.
188. Drummond PD, Lance JW. Thermographic changes in cluster headache. Neurology. 1984; 34:1292-8. [IDIS 191821] [PubMed 6541301]
189. Rapoport AM, Visser WH, Cutler NR et al. Oral sumatriptan in preventing headache recurrence after treatment of migraine attacks with subcutaneous sumatriptan. Neurology. 1995; 45:1505-9. [IDIS 351281] [PubMed 7644049]
190. Cutler N, Mushet GR, Davis R et al. Oral sumatriptan for the acute treatment of migraine: evaluation of three dosage strengths. Neurology. 1995; 45(Suppl 7):S5-9.
191. Rederich G, Rapoport A, Cutler N et al. Oral sumatriptan for the long-term treatment of migraine: clinical findings. Neurology. 1995; 45(Suppl 7):S15-20.
192. Blier P, Bergeron R. The safety of concomitant use of sumatriptan and antidepressant treatments. J Clin Psychopharmacol. 1995; 15:106-9. [IDIS 345845] [PubMed 7782482]
193. Diamond S. The use of sumatriptan in patients on monoamine oxidase inhibitors. Neurology. 1995; 45:1039-40. [IDIS 348476] [PubMed 7783861]
194. Kelly KM. Cardiac arrest following use of sumatriptan. Neurology. 1995; 45:1211-3. [IDIS 348482] [PubMed 7783891]
195. Goadsby PJ, Olesen J. Diagnosis and management of migraine. BMJ. 1996; 312:1279-83. [IDIS 365075] [PubMed 8634619]
196. Edvinsson L, Goadsby PJ. Neuropeptides in migraine and cluster headache. Cephalalgia. 1994; 14:320-7. [PubMed 7828188]
197. Moskowitz MA. Neurogenic inflammation in the pathophysiology and treatment of migraine. Neurology. 1993; 43(Suppl 3):S16-20. [PubMed 8389008]
198. Headache Classification Committee of the International Headache Society. Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. Cephalalgia. 1988; 8(Suppl 7):19-28.
199. Robbins L. Intranasal lidocaine for cluster headache. Headache. 1995; 35:83- 4. [PubMed 7737866]
200. Kudrow L, Kudrow DB. Intranasal lidocaine. Headache. 1995; 35:565-6. [PubMed 8530286]
201. Kittrelle JP, Grouse DS, Seybold ME. Cluster headache: local anesthetic abortive agents. Arch Neurol. 1985; 42:496-8. [PubMed 3994568]
202. Ghose RR. SUNCT syndrome. Med J Aust. 1995; 162:667-8. [IDIS 349917] [PubMed 7603383]
203. Choi A, Laurito CE, Cunningham FE. Pharmacologic management of postdural puncture headache. Ann Pharmacother. 1996; 30:831-9. [IDIS 369043] [PubMed 8826568]
204. Burtscher M, Likar R, Nachbauer W et al. Ibuprofen versus sumatriptan for high- altitude headache. Lancet. 1995; 346:254-5. [IDIS 351898] [PubMed 7616830]
205. Mathew NT. Long-term subcutaneous sumatriptan in cluster headache. Cephalalgia. 1995; 15:164. [PubMed 7553802]
206. Benson JM, Zorn SL, Book LS. Sumatriptan in the treatment of cyclic vomiting. Ann Pharmacother. 1995; 29:997-9. [IDIS 354740] [PubMed 8845562]
207. Maizels M, Scott B, Cohen W et al. Intranasal lidocaine for treatment of migraine. JAMA. 1996; 276:319-21. [IDIS 368694] [PubMed 8656545]
208. Kudrow L, Kudrow DB, Sandweiss JH. Rapid and sustained relief of migraine attacks with intranasal lidocaine: preliminary findings. Headache. 1995; 35:79-82. [PubMed 7737865]
209. Ekbom K, Waldenlind E, Cole J et al. Sumatriptan in chronic cluster headache: results of continuous treatment for eleven months. Cephalalgia. 1992; 12:254-6. [PubMed 1326405]
210. Stovner LJ, Sjaastad O. Treatment of headache and its variants. Curr Opin Neurol. 1995; 8:243-7. [PubMed 7551127]
211. Stratton SJ. Sumatriptan: a clinical standard? Ann Emerg Med. 1995; 25:538- 9. Letter. (IDIS 345057)
212. Stratton SJ. Sumatriptan and migraine. Ann Emerg Med. 1996; 27:388. [IDIS 361196] [PubMed 8599507]
213. Akpunonu BE, Mutgi AB. Sumatriptan and migraine. Ann Emerg Med. 1996; 27:387-8. [IDIS 361195] [PubMed 8599506]
214. Dahlof C, Ekbom K, Persson L. Clinical experiences from Sweden on the use of subcutaneously administered sumatriptan in migraine and cluster headache. Arch Neurol. 1994; 51:1256-61. [PubMed 7986182]
215. Anthony M, Hinterberger H, Lance JW. Plasma serotonin in migraine and stress. Arch Neurol. 1967; 16:544-52. [PubMed 5297855]
216. Kimball RW, Friedman AP, Vallejo E. Effect of serotonin in migraine patients. Neurology. 1960; 10:107-11. [PubMed 14409092]
217. Wilkinson M, Pfaffenrath V, Schoenen J et al. Migraine and cluster headache—their management with sumatriptan: a critical review of the current clinical experience. Cephalalgia. 1995; 15:337-57. [PubMed 8536293]
218. Mueller L, Gallagher RM, Ciervo CA. Vasospasm-induced myocardial infarction with sumatriptan. Headache. 1996; 36:329-31. [PubMed 8682677]
219. Shader RI. I read a recent report suggesting a causal relationship between a dystonic reaction in a patient and her use of sumatriptan. Is this likely? J Clin Psychopharmacol. 1995; 15:231. Commentary. (IDIS 347590)
220. Ottervanger JP, van Witsen TB, Valkenburg HA et al. Adverse reactions attributed to sumatriptan: a postmarketing study in general practice. Eur J Clin Pharmacol. 1994; 47:305-9. [IDIS 340281] [PubMed 7875179]
221. Dachs R, Vitillo J. Angioedema associated with sumatriptan administration. Am J Med. 1995; 99:684-5. [PubMed 7503094]
222. Bakshi R, Yan-Go FL. Prolonged marijuana-like dysphoria after subcutaneous sumatriptan. Ann Pharmcother. 1996; 30:683.
223. Fuller RW. Mechanisms and functions of serotonin neuronal systems: opportunities for neuropeptide interactions. Ann NY Acad Sci. 1996; 780:176-84. [PubMed 8602731]
224. Pierce PA, Xie GX, Peroutka SJ et al. Dual effect of the serotonin agonist, sumatriptan, on peripheral neurogenic inflammation. Reg Anesth. 1996; 21:219-25. [PubMed 8744664]
225. Facchinetti F, Bonellie G, Kangasniemi P et al et al. The efficacy and safety of subcutaneous sumatriptan in the acute treatment of menstrual migraine. Obstet Gynecol. 1995; 86:911-6. [IDIS 356476] [PubMed 7501338]
226. Winner P, Ricalde O, Le Force B et al. A double-blind study of subcutaneous dihydroergotamine vs subcutaneous sumatriptan in the treatment of acute migraine. Arch Neurol. 1996; 53:180-4. [PubMed 8639069]
227. Stallard N, Barry P. Another complication of the combined extradural-subarachnoid technique. Br J Anaesth. 1995; 75:370-1. [IDIS 352994] [PubMed 7547064]
228. Gawel MJ, Rothbart P, Jacobs H. Subcutaneous sumatriptan in the treatment of acute episodes of posttraumatic headache. Headache. 1993; 33:96-7. [PubMed 8384612]
229. Dahlof C. Subcutaneous sumatriptan does not abort attacks of chronic paroxysmal hemicrania (CPH). Headache. 1993; 33:201-2. [PubMed 8388371]
230. Hannerz J, Jogestrand T. Intracranial hypertension and sumatriptan efficacy in a case of chronic paroxysmal hemicrania which became bilateral. Headache. 1993; 33:320-3. [PubMed 8394301]
231. Hannerz J, Greitz D, Hansson P et al. SUNCT may be another manifestation of orbital venous vasculitis. Headache. 1992; 32:384-9. [PubMed 1399559]
232. Bonuccelli U, Nuti A, Lucetti C et al. Amitriptyline and dexamethasone combined treatment in drug-induced headache. Cephalalgia. 1996; 16:197-200.
233. Hannington-Kiff JG. Sumatriptan relieves and prevents peri-operative migraine attacks. Anaesthesia. 1993; 48:144-6. [PubMed 8384803]
234. Wing Y-K, Clifford EM, Sheehan BD et al. Paroxetine treatment and the prolactin response to sumatriptan. Psychopharmacology. 1996; 124:377-9. [PubMed 8739554]
235. Schenker S, Yang Y, Perez A et al. Sumatriptan (Imitrex) transport by the human placenta. (43941) Proc Soc Exp Biol Med. 1995; 210:213-20.
236. Glaxo Wellcome, Research Triangle Park, NC: Personal communication.
237. Reviewers’ comments (personal observations).
238. Nielsen TH, Tfelt-Hansen P. Lack of effect of GR43175 on peripheral arteries in man. Cephalalgia. 1989; 9(Suppl 9):93-5. [PubMed 2544291]
239. Doenicke A, Brand J, Perrin VL. Possible benefit of GR43175, a novel 5-HT1-like receptor agonist, for the acute treatment of severe migraine. Lancet. 1988; 1:1309-11. [IDIS 243109] [PubMed 2897560]
240. Hoerlein M, McMonigle G, Franz DN. Sumatriptan therapy of pediatric migraines. Ann Neurol. 1994; 36:548.
241. Linder SL. Subcutaneous sumatriptan in the clinical setting: the first fifty consecutive patients with acute migraine in a pediatric neurology office practice. Headache. 1995; 35:292-3.
242. Wojnar-Horton RE, Hackett LP, Yapp P et al. Distribution and excretion of sumatriptan in human milk. Br J Clin Pharmacol. 1996; 41:217-21. [IDIS 365036] [PubMed 8866921]
243. Salonen R, Ashford E, Dahlöf C et al et al. Intranasal sumatriptan for the acute treatment of migraine. J Neurol. 1994; 241:463-9. [PubMed 7964913]
244. Pryse-Phillips WEM, Dodick DW, Edmeads JG et al. Guidelines for the diagnosis and management of migraine in clinical practice. CMAJ. 1997; 156:1273-87. [IDIS 384971] [PubMed 9145054]
245. Danish Neurological Society and the Danish Headache Society. Guidelines for the management of headache. Cephalalgia. 1998; 18:9-22. [PubMed 9601619]
246. Peroutka SJ. Drugs effective in the therapy of migraine. In: Hardman JG, Limbird LE, Molinoff PB et al, eds. Goodman and Gilman’s the pharmacological basis of therapeutics. 9th ed. New York: McGraw-Hill; 1995:487-502.
247. Young WB, Silberstein SD, Dayno JM. Migraine treatment. Semin Neurol. 1997; 17:325-33. [PubMed 9474712]
248. Anon. New triptans and other drugs for migraine. Med Lett Drugs Ther. 1998; 40:97-100. [PubMed 9793036]
249. GlaxoSmithKline. Imitrex (sumatriptan) nasal spray prescribing information. Research Triangle Park, NC; 2012 Mar.
250. Novartis Pharmaceuticals. Migranal(dihydroergotamine mesylate) nasal spray prescribing information. East Hanover, NJ; 1997 Dec.
251. Diamond S. Recommendations for primary care providers: diagnosis and treatment of migraine. Headache Q. 1997; Suppl: 6-14.
252. Posner JB. Disorders of sensation. In: Wyngaarden JB, Smith LH Jr, Bennett JC, eds. Cecil textbook of medicine. 19th ed. Philadelphia: WB Saunders Company; 1992:2116-2123.
253. Raskin NH. Migraine and the cluster headache syndrome. In: Fauci AS, Braunwald E, Isselbacher KJ et al, eds. Harrison’s principles of internal medicine. 14th ed. New York: McGraw-Hill Company; 1998:2307-11.
254. May A, Bahra A, Büchel C et al. Hypothalamic activation in cluster headache attacks. Lancet. 1998; 352:275-8. [PubMed 9690407]
255. Schoenen J. Cluster headaches—central or peripheral in origin? Lancet. 1998; 352:253-5.
256. Dahlof C. Placebo controlled trials with ergotamine in the acute treatment of migraine. Cephalalgia. 1993; 13:166-71. [PubMed 8358774]
257. Lipton RB, Stewart WF, Ryan RE. Efficacy and safety of acetaminophen, aspirin, and caffeine in alleviating migraine headache pain.: three double-blind, randomized, placebo-controlled trials. Arch Neurol. 1998; 55:210-7. [PubMed 9482363]
258. Brown GR. Stadol dependence: another case. JAMM. 1985; 254:910.
259. Austin RP. Diversion of butorphanol. Am J Hosp Pharm. 1983; 40:1306. [PubMed 6614013]
260. Hoover RC, Williams RB. Survey of butorphanol and nalbuphine diversion in U.S. hospitals. Am J Hosp Pharm. 1985; 42:1111-3. [PubMed 4003423]
261. Butorphanol. In: WHO Expert Committee on Durg Dependence. 25th report. Technical report series 775. Geneva: World Health Organization; 1989:24-6.
262. Glaxo Wellcome. Amerge (naratriptan hydrochloride) tablets prescribing information. Research Triangle Park, NC; 1998 Feb.
263. Merck & Co. Maxalt (rizatriptan benzoate) tablets prescribing information. West Point, PA; 1998 June.
264. Zeneca Pharmaceuticals. Zomig (zolmitriptan) tablets prescribing information. Wilmington, DE; 1997 Dec 1.
265. Schoenen J, Jacquy J, Lenaerts M. Effectiveness of high-dose riboflavin in migraine prophylaxis; a randomized controlled trial. Neurology. 1998; 50:466-70. [IDIS 401485] [PubMed 9484373]
266. Mattimoe D, Newton W. High-dose riboflavin for migraine prophylaxis. J Fam Pract. 1998; 47:11. [PubMed 9673596]
267. Diener HC, Kaube H, Limmroth V. A practical guide to the management and prevention of migraine. Drugs. 1998; 56:811-24. [PubMed 9829155]
268. Ramadan NM, Silberstein SD, Freitag FG et al. Evidence-based guidelines for migraine headache in the primary care setting: pharmacological management for prevention of migraine. St. Paul, MN; 2001. From the American Academy of Neurology website ().
269. Matchar DB, Young WB, Rosenberg JH et al. Evidence-based guidelines for migraine headache in the primary care setting: pharmacological management of acute attacks. St. Paul, MN; 2001. From American Academy of Neurology web site ().
270. Ryan R, Elkind A, Baker CC et al. Sumatriptan nasal spray for the acute treatment of migraine: Results of two clinical studies. Neurology. 1997; 49:1193-5. [IDIS 397203] [PubMed 9371890]
271. Diamond S, Elkind A, Jackson RT et al. Multiple-attack efficacy and tolerability of sumatriptan nasal spray in the treatment of migraine. Arch Fam Med. 1997; 130:1-12.
272. Food and Drug Administration. Public health advisory: combined use of 5-hydroxytryptamine receptor agonists (triptans), selective serotonin reuptake inhibitors (SSRIs) or selective serotonin/norepinephirne reuptake inhibitors (SNRIs) may result in life-threatening serotonin syndrome. Rockville, MD; 2006 Jul 19. From the FDA website: ( and ).
276. Tepper SJ, Tepper DE. Breaking the cycle of medication overuse headache. Cleve Clin J Med. 2010; 77:236-42. [PubMed 20360117]
277. Negro A, Martelletti P. Chronic migraine plus medication overuse headache: two entities or not?. J Headache Pain. 2011; 12:593-601. [PubMed 21938457]
278. Bijl D. The serotonin syndrome. Neth J Med. 2004; 62:309-13. [PubMed 15635814]
279. Pfizer. Alsuma (sumatriptan succinate) injection prescribing information. New York, NY; 2012 Dec.
280. Zogenix, Inc. Sumavel DosePro (sumatriptan succinate) injection prescribing information. San Diego, CA; 2011 Jun.
281. GlaxoSmithKline. Treximet (sumatriptan succinate and naproxen sodium) tablets prescribing information. Research Triangle Park, NC; 2012 Oct.
282. Brandes JL, Kudrow D, Stark SR et al. Sumatriptan-naproxen for acute treatment of migraine: a randomized trial. JAMA. 2007; 297:1443-54. [PubMed 17405970]
283. Sumatriptan. In: Briggs GG, Freeman RK, Yaffe SJ. Drugs in pregnancy and lactation: a reference guide to fetal and neonatal risk. 9th ed. Philadelphia: Lippincott Williams & Wilkins; 2011:1376-9.
284. GlaxoSmithKline. Patients instructions for use: Imitrex STATdose System. Research Triangle Park, NC; 2012.
285. Gregor N, Schlesiger C, Akova-Oztürk E et al. Treatment of cluster headache attacks with less than 6 mg subcutaneous sumatriptan. Headache. 2005; 45:1069-72.