Sumatriptan Succinate

Pronunciation

Class: Selective Serotonin Agonists
VA Class: CN105
Chemical Name: C14H21N3O2S
Molecular Formula: C14H21N3O2S•C4H6O4
CAS Number: 103628-46-2
Brands: Alsuma, Imitrex, Sumavel, Treximet

Introduction

Selective serotonin (5-hydroxytryptamine; 5-HT) type 1B and 1D receptor agonist (“triptan”).1 2 3 4 5 6 7 8 223 224 268

Uses for Sumatriptan Succinate

Vascular Headaches

Acute treatment of migraine attacks with or without aura.1 2 3 6 7 8 9 10 13 48 80 145 148 184 195 214 217 225 249 279 280

Slideshow: Living with Your Migraines: Tips for Treatment and Prevention

Sub-Q for acute treatment of cluster headache episodes.1 2 49 75 183 184 185 210 214 279 280 Safety and efficacy of oral or intranasal sumatriptan for this use not established.148 249

Not recommended for management of hemiplegic or basilar migraine or for prophylaxis of migraine or cluster headache.1 7 114 158

Sumatriptan Succinate Dosage and Administration

Administration

Administer orally, intranasally, or by sub-Q injection.1 12 148 249 Do not administer IM or IV; IV administration may induce coronary vasospasm.1 13 40 90 236 237 279 280

To achieve maximum relief, initiate therapy as soon as possible after onset of migraine attack.50 92 108 124 148 180 237

Oral 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

Intranasal Administration

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

Sub-Q Administration

Administer only by sub-Q injection.1 279 280

Do not administer IM or IV; IV administration may induce coronary vasospasm.1 13 40 90 236 237 279 280

Autoinjection devices are available to facilitate self-administration of 4- or 6-mg dose.1 279 280

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

Dosage

Available as sumatriptan (nasal solution) and sumatriptan succinate (tablets and injection); dosage expressed in terms of sumatriptan.1 148 249

Following failure to respond to first dose, reconsider diagnosis of migraine prior to administration of a second dose.1 148 249

Adults

Vascular Headaches
Migraine
Oral (Sumatriptan)

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.148

Oral (Sumatriptan/Naproxen)

Sumatriptan 85 mg (with naproxen sodium 500 mg) as a single dose.281

Efficacy of >1 dose not established.281 If a second dose is administered, allow ≥2 hours to elapse between the first and second doses.281

Intranasal

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.249

Sub-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, a 6-mg sub-Q dose may be repeated once after ≥1 hour or additional oral doses may be administered at intervals ≥2 hours, up to a maximum oral dosage of 100 mg daily.1 148

If patient does not respond to first 6-mg dose, additional doses are unlikely to provide benefit.2 3 6 7 8 9 174 176 181 236 237

Cluster Headache
Sub-Q

≤6 mg as a single dose.1 Manufacturers state that efficacy of doses <6 mg not established;1 however, some patients may derive benefit from such lower doses (e.g., 3 mg).13 210 285

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

If patient does not respond to first 6-mg dose, additional doses are unlikely to provide benefit.1 2 3 6 7 8 9 174 176 181 236 237

Prescribing Limits

Adults

Vascular Headaches
Migraine
Oral (Sumatriptan)

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.148

Oral (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.281

Intranasal

Maximum 40 mg daily.249

Safety of treating an average of >4 headaches per 30-day period has not been established.249

Sub-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

Cluster Headache
Sub-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

Special Populations

Hepatic Impairment

Contraindicated in patients with severe hepatic impairment.1 148 249

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

Geriatric Patients

Select dosage with caution, usually starting at the low end of the dosage range.1

Cautions for Sumatriptan Succinate

Contraindications

  • Ischemic heart disease (e.g., angina pectoris, history of MI, documented silent ischemia).1 148 249

  • Coronary artery vasospasm (e.g., Prinzmetal variant angina).1 148 249

  • Wolff-Parkinson-White syndrome or cardiac arrhythmias associated with other accessory pathway conduction disorders.1

  • Uncontrolled hypertension.1 148 249

  • Other serious underlying cardiovascular disease.148 249

  • History of stroke or TIA.1 148 249

  • Peripheral vascular disease or ischemic bowel disease.1 148 249

  • Hemiplegic or basilar migraine.1 148 249

  • Treatment within previous 24 hours with another 5-HT1 receptor agonist or an ergot alkaloid.1 148 249 (See Specific Drugs under Interactions.)

  • Concurrent or recent (within 2 weeks) treatment with an MAO-A inhibitor.1 148 249

  • Severe hepatic impairment.1 148 249

  • Known hypersensitivity to sumatriptan or any ingredient in the formulation.1 148 249

Warnings/Precautions

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

Cardiac Effects

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

Possible fatal or life-threatening cardiac rhythm disturbances (e.g., ventricular tachycardia or fibrillation).1 148 249 Discontinue if such disturbances occur.1

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

If evaluation provides evidence of CAD or coronary vasospasm, do not administer the drug.1 148 249

If results of evaluation are satisfactory, consider administering the initial dose in a medically supervised setting followed immediately by an ECG.1 40 148 236 237 249

Periodic cardiovascular evaluation recommended in patients with risk factors for CAD if receiving intermittent long-term therapy.1 148 236 237 249

Cerebrovascular Events

Possible cerebral or subarachnoid hemorrhage and stroke, sometimes fatal.1 148 249 (See Careful Diagnosis of Migraine under Cautions.) Discontinue therapy if a cerebrovascular event occurs.1

Risk of certain cerebrovascular events (e.g., stroke, hemorrhage, TIA) may be increased in patients with migraine.1 148 249

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

If signs or symptoms suggestive of vasospasm occur following administration, evaluate patient to rule out vasospastic reaction before administering additional doses.1 6 8 148 249

Hypertensive Effects

Substantial increases in BP, including hypertensive crisis with acute impairment of organ systems, reported rarely in patients with or without history of hypertension.1 148 249

Administer with caution in patients with controlled hypertension as transient increases in BP and peripheral vascular resistance are possible.3 11 148 249 (See Contraindications under Cautions.)

Monitor BP in all patients receiving the drug.1

Serotonin Syndrome

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

If manifestations of serotonin syndrome occur, discontinue sumatriptan and any concurrently administered serotonergic agents and initiate supportive and symptomatic treatment.1 148 249 278

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

Local Effects

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

Sensitivity Reactions

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

Seizures

Seizures reported rarely; use with caution in patients with a history of seizures or with conditions associated with a lowered seizure threshold.1 148 249

Ocular Effects

Corneal opacities and corneal epithelial defects reported in dogs.1 148 249

Use of Fixed Combinations

When used in fixed combination with naproxen, consider the cautions, precautions, and contraindications associated with naproxen.281

Specific Populations

Pregnancy

Category C.1 148 249

Lactation

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

Pediatric Use

Safety and efficacy not established in children <18 years of age;1 12 148 236 237 249 use not recommended.1 148 249 Serious adverse events reported in children receiving sumatriptan.1 148 249

Geriatric Use

Insufficient experience in patients ≥65 years of age to determine whether geriatric patients respond differently than younger adults.1

Potential for more pronounced increases in BP; consider increased risk for CAD in geriatric patients.1 148 249 (See Cardiac Effects under Cautions.)

Select dosage with caution.1 Consider the greater frequency of decreased hepatic, renal, and/or cardiac function and of concomitant disease and drug therapy observed in the elderly.1

Hepatic Impairment

Contraindicated in patients with severe hepatic impairment.1 148 249

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 Sumatriptan Succinate

Metabolized principally by MAO-A isoenzyme in vitro.148

Protein-bound Drugs

Effect on protein binding of other drugs has not been evaluated,1 but expected to be minor due to low-level protein binding of sumatriptan.148 249

Specific Drugs

Drug

Interaction

Comments

Acetaminophen

Pretreatment with oral sumatriptan followed by acetaminophen affected rate, but not extent of acetaminophen absorption over 8 hours187

Alcohol

Administration of alcohol 30 minutes prior to oral sumatriptan did not affect sumatriptan pharmacokinetics44 45 148 236

Amitriptyline

Concomitant use did not affect sumatriptan efficacy40 62

Antidepressants, SSRIs (e.g., citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline) and SNRIs (e.g., duloxetine, venlafaxine)

Potentially life-threatening serotonin syndrome1 148 249 272

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])

Additive vasospastic effects1 148 249

Use within 24 hours contraindicated1 148 249

5-HT1receptor agonists

Additive vasospastic effects1 148 249

Use within 24 hours contraindicated1 148 249

MAO inhibitors

MAO-A inhibitors decrease sumatriptan clearance, resulting in substantially increased systemic exposure; no substantial effect on sumatriptan metabolism seen with an MAO-B inhibitor1 148 249

Use within 2 weeks of MAO-A inhibitor contraindicated1 26 37 148 157 236 249

Propranolol

Concomitant use did not affect sumatriptan efficacy;40 62 pretreatment with propranolol did not alter pharmacokinetics or pharmacodynamics of oral sumatriptan62

Verapamil

Concomitant use did not affect sumatriptan efficacy40 62

Xylometazoline

Topical application of xylometazoline to nasal mucosa 15 minutes prior to intranasal sumatriptan did not affect sumatriptan pharmacokinetics249

Sumatriptan Succinate Pharmacokinetics

Absorption

Bioavailability

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 injection via injection pen or manually in deltoid area or thigh, time to peak concentration and amount of drug absorbed was not affected by injection site or technique.1 279

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

Special Populations

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

Moderate hepatic impairment did not alter pharmacokinetics of sub-Q sumatriptan.1 Effect of severe hepatic impairment on pharmacokinetics of sub-Q sumatriptan not established.1

Onset

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 intranasal administration, onset of headache relief occurs within 30 minutes following a 10-, 20-, or 40-mg dose.123 243

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

Food

Food does not appreciably affect oral bioavailability, but prolongs time to peak concentration.2 13 44 148 281

Distribution

Extent

Rapidly and widely distributed into body tissues after sub-Q administration.1 14 146 148 168

Distributed into human milk;1 148 only small amounts cross placenta by passive transport in vitro.235

Plasma Protein Binding

Approximately 14–21%.1 14 45 148

Elimination

Metabolism

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

Elimination Route

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

Half-life

1.5–2.6 hours.1 6 44 45 78 79 89 91 148 166 168 249 280 281

Special Populations

In patients with renal impairment, pharmacokinetics not evaluated, but little clinical effect expected since drug is largely metabolized to an inactive metabolite.1 148 249

Stability

Storage

Oral

Tablets

Sumatriptan: 2–30°C.148

Sumatriptan/naproxen: 25°C (may be exposed to 15–30°C).281 Store in original container with desiccant packet; do not repackage.281

Intranasal

Solution

2–30°C; protect from light.249

Parenteral

Injection

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

Actions

  • Binds with high affinity to 5-HT type 1-like receptors, probably 5-HT1B and 5-HT1D subtypes.1 2 3 4 5 6 7 8 223 224

  • 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

  • Risk of somnolence or dizziness; advise patient to avoid performing hazardous activities that require mental alertness (e.g., driving, operating machinery) if such effects occur.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 taking sumatriptan exactly as prescribed.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

  • Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.1 148 249

  • Importance of informing patients of other important precautionary information.1 148 249 (See Cautions.)

Preparations

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

Sumatriptan

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Nasal

Solution

5 mg/0.1 mL*

Imitrex Nasal Spray

GlaxoSmithKline

Sumatriptan Nasal Spray

20 mg/0.1 mL*

Imitrex Nasal Spray

GlaxoSmithKline

Sumatriptan Nasal Spray

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Sumatriptan Succinate

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Tablets, film-coated

25 mg (of sumatriptan)*

Imitrex

GlaxoSmithKline

Sumatriptan Succinate Tablets

50 mg (of sumatriptan)*

Imitrex

GlaxoSmithKline

Sumatriptan Succinate Tablets

100 mg (of sumatriptan)*

Imitrex

GlaxoSmithKline

Sumatriptan Succinate Tablets

Parenteral

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)

GlaxoSmithKline

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)

Pfizer

Imitrex (available in 0.5-mL unit-of-use injection-pen cartridges and as 0.5-mL single-dose vials)

GlaxoSmithKline

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)

Zogenix

Sumatriptan Succinate Combinations

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Tablets, film-coated

85 mg (of sumatriptan) with 500 mg Naproxen Sodium

Treximet

GlaxoSmithKline

Comparative Pricing

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.

References

1. GlaxoSmithKline. Imitrex (sumatriptan succinate) injection prescribing information. Research Triangle Park, NC; 2012 Oct.

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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]

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