Home Drug Guide Sumatriptan

Drug Guide

Generic Name

Sumatriptan

Brand Names Imitrex, Tosymra

Classification

Therapeutic: Antimigraine agent

Pharmacological: Serotonin receptor agonist (triptan)

FDA Approved Indications

Migraine attacks with or without aura
Cluster headaches

Mechanism of Action

Selective agonist for 5-HT1B/1D receptors, leading to vasoconstriction of intracranial blood vessels, inhibition of inflammatory neuropeptide release, and interruption of migraine pain pathways.

Dosage and Administration

Adult: Typically 25-100 mg orally at symptom onset; may repeat in 2-hour intervals, not exceeding 200 mg/day.

Pediatric: Use not established; consult specific pediatric guidelines or specialist.

Geriatric: Start at lower end of dosing range, monitor for cardiovascular effects.

Renal Impairment: Use with caution; dose adjustment may be necessary.

Hepatic Impairment: Starting dose should be reduced; hepatic function should be monitored.

Pharmacokinetics

Absorption: Rapid, peak plasma levels within 2-3 hours after oral dose.

Distribution: Widely distributed; crosses the blood-brain barrier.

Metabolism: Primarily hepatic via monoamine oxidase A (MAO-A), and also by other pathways.

Excretion: Renal (mainly as metabolites), fecal.

Half Life: Approx. 2 hours.

Contraindications

Coronary artery disease, history of stroke or TIA, uncontrolled hypertension, basilar or hemiplegic migraine, ischemic heart disease.

Precautions

Use with caution in patients with liver disease, hypertension, or risk factors for cardiovascular disease. Not recommended during pregnancy unless benefits outweigh risks.

Adverse Reactions - Common

Sensations of tingling, warmth, flushing (Common)
Dizziness, drowsiness (Common)

Adverse Reactions - Serious

Coronary vasospasm leading to myocardial infarction (Rare)
Serotonin syndrome (when combined with serotonergic agents) (Rare)
Allergic reactions including anaphylaxis (Rare)

Drug-Drug Interactions

SSRIs, SNRIs, MAO inhibitors (risk of serotonin syndrome)
Other vasoconstrictive agents

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor cardiovascular status before and after administration, especially in at-risk populations.

Diagnoses:

Risk for ineffective tissue perfusion related to vasospasm.
Pain related to migraine.

Implementation: Administer at onset of migraine symptoms, ensure patient understands dosing limits.

Evaluation: Assess relief of migraine symptoms within 2 hours, monitor for adverse effects.

Patient/Family Teaching

Instruct to take at first sign of migraine for best effectiveness.
Avoid activities requiring alertness immediately after taking.
Report chest pain, severe dizziness, or allergic reactions immediately.

Special Considerations

Black Box Warnings:

Cardiovascular risk: avoid in patients with ischemic heart disease or risk factors for cardiovascular disease.

Genetic Factors: None specifically tied to genetic factors but consider CYP2D6 metabolism for some formulations.

Lab Test Interference: None known.

Overdose Management

Signs/Symptoms: Severe hypertension, coronary vasospasm, CNS disturbances.

Treatment: Supportive care; no specific antidote exists, manage symptoms and provide cardiovascular support as needed.

Storage and Handling

Storage: Store at room temperature away from moisture and light.

Stability: Stable for 2-3 years if properly stored.