Pregnancy Risk Category C
How supplied
Tablets: 25 mg, 50 mg, 100 mg (base)†
Injection: 6 mg/0.5 ml (12 mg/ml) in 0.5-ml prefilled syringes and vials
Nasal solution: 5 mg/0.1 ml; 20 mg/0.1 ml
Action
Unknown. May selectively activate vascular serotonin (5-hydroxytryptamine, 5-HT) receptors. Stimulation of the specific receptor subtype 5-HT1, present on cranial arteries and the dura mater, causes vasoconstriction of cerebral vessels but has minimal effects on systemic vessels, tissue perfusion, and blood pressure.
Indications & dosage
Acute migraine attacks (with or without aura)--
Adults: 6 mg S.C. Maximum recommended dose is two 6-mg injections daily, with at least 1 hour between injections. Or, initially 25 to 100 mg P.O. and a second dose of up to 100 mg in 2 hours, if needed. Additional doses may be given q 2 hours, p.r.n., to maximum P.O. dose of 300 mg/day. Intranasal dosage is 5 to 20 mg sprayed into one nostril (if a 10-mg dose is needed, 5 mg is sprayed into each nostril). If needed, dosing may be repeated after 2 hours, to maximum of 40 mg daily.
Adverse reactions
CNS: dizziness, vertigo, drowsiness, headache, anxiety, malaise, fatigue, burning sensation, tingling, warm or hot sensation, feeling of strangeness, tight feeling in head, cold sensation; heaviness, pressure, or tightness.
CV: pressure or tightness in chest, atrial fibrillation, ventricular fibrillation, ventricular tachycardia, MI, flushing.
EENT: discomfort of throat, nasal cavity or sinus, mouth, jaw, or tongue; altered vision.
GI: abdominal discomfort, dysphagia.
Musculoskeletal: myalgia, muscle cramps, neck pain.
Skin: diaphoresis.
Other: injection site reaction.
Interactions
Drug-drug. Ergot and ergot derivatives: prolonged vasospastic effects. Don't use these drugs and sumatriptan within the same 24-hour period.
MAO inhibitors: increased effects of sumatriptan. Avoid concomitant use or using within 2 weeks of discontinuing MAO inhibitor therapy.
Drug-herb. Horehound: may enhance serotonergic effects. Avoid concomitant use.
Effects on diagnostic tests
None reported.
Contraindications
Contraindicated in patients with hypersensitivity to drug and in those with uncontrolled hypertension or ischemic heart disease (such as angina pectoris, Prinzmetal's angina, history of MI, or documented silent ischemia), or hemiplegic or basilar migraine. Also contraindicated in those taking ergotamine or within 14 days of MAO inhibitor therapy.
Nursing considerations
Patient teaching
*Liquid contains alcohol. **May contain tartrazine. †Canada ‡Australia §U.K. OTCOver the counter
Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE-THREATENING