Use in Adults
Triptan Injections

​THIS GUIDE PROVIDES A PARTIAL LISTING OF PRESCRIBING INFORMATION FOR THIS MEDICATION. FOR A FULL LISTING OF PRESCRIBING INFORMATION PLEASE REFER TO THE PACKAGE INSERT. CLICK ON THE BRAND NAME® TO VIEW THE LINK TO THE PACKAGE INSERT.

SUMATRIPTAN (IMITREX®, SUMAVEL DOSE PRO®, ZEMBRACE SYMTOUCH®, )​
​
​BRANDS:

• IMITREX® (SUMATRIPTAN) FOR MORE COMPLETE PRESCRIBING INFORMATION CLICK HERE FOR PACKAGE INSERT
• SUMAVEL DOSE PRO® (SUMATRIPTAN) FOR MORE COMPLETE PRESCRIBING INFORMATION CLICK HERE FOR PACKAGE INSERT
• ZEMBRACE SYMTOUCH® (SUMATRIPTAN) FOR MORE COMPLETE PRESCRIBING INFORMATION CLICK HERE FOR PACKAGE INSERT

AVAILABLE DOSAGES:

• 3, 4 AND 6 MG INJECTABLES

INITIAL DOSE:

• STANDARD DOSAGE FOR ACUTE MIGRAINE ATTACKS IS 6 MG
• 3 OR 4 MG DOSAGES CAN ALSO BE USED AS INITIAL THERAPY AND PROBABLY HAVE A LOWER SIDE EFFECT PROFILE THAN THE 6 MG DOSAGE

​DOSE SCHEDULE:

• 3 TO 6 MG SUBCUTANEOUSLY ADMINISTERED AT ONSET OF MIGRAINE OF ATTACK BUT MAY BE TAKEN AT ANY POINT DURING MIGRAINE ATTACK.
• MAY REPEAT DOSE IN 1 HOUR IF NOT PAIN FREE OR WITHOUT ADEQUATE PAIN RELIEF.
• IF PAIN FREE AT 1-2 HOURS AFTER THE INITIAL DOSAGE, BUT THE PAIN RETURNS 2-24 HOURS LATER MAY REPEAT A SECOND DOSAGE

​MAX DAILY DOSE:

• 12 MG

COMMON SIDE EFFECTS:

• TIGHTNESS IN THROAT AND CHEST, DIZZINESS, OR SEDATION/FATIGUE, TINGLING IN THE HANDS AND FEET

HEADACHE SPECIALIST COMMENTS: 

• SUBCUTANEOUS SUMATRIPTAN MAY BE PREFERRED FOR MIGRAINE ATTACKS THAT REACH PEAK INTENSITY QUICKLY AND FOR AWAKENING MIGRAINE ATTACKS AS THESE MIGRAINE ATTACKS TEND TO BE MORE SEVERE AND OFTEN ARE MORE REFRACTORY TO ACUTE THERAPY.
• PROBABLY HIGHER EFFICACY THAN ORAL TRIPTANS, ALTHOUGH SIDE EFFECT PROFILE MAY BE HIGHER.
• CAN BE USED AS RESCUE THERAPY IN A PERSON WHOSE HEADACHE THAT HAS NOT RESPONDED TO ORAL SUMATRIPTAN OR OTHER PRIMARY ACUTE THERAPIES.
• TRIPTANS HAVE A HIGHER INCIDENCE OF SIDE EFFECTS THAN MANY NSAIDS AND GEPANTS.   SIDE EFFECTS INCLUDE PARESTHESIAS, NECK TIGHTNESS, CHEST PAIN/DISCOMFORT, DIZZINESS AND SOMNOLENCE, WHICH HAVE BEEN TERMED “TRIPTAN SIDE EFFECTS”.  PATIENTS NEED TO BE WARNED OF THESE SIDE EFFECTS PRIOR TO THEIR INITIAL USE.    IF NOT, SOME PATIENTS MAY DELAY USE OF TRIPTANS BECAUSE OF FEAR OF THESE SIDE EFFECTS. 
• SUMATRIPTAN SHOULD NOT BE USED IN THOSE WITH KNOWN CARDIOVASCULAR DISEASE (CAD, STROKE, PRINZMETAL’S ANGINA, PERIPHERAL VASCULAR DISEASE, MESENTERIC ISCHEMIA), HEMIPLEGIC MIGRAINE AND BASILAR TYPE MIGRAINE.  IT SHOULD BE USED WITH CAUTION IN THOSE WITH TWO MORE CARDIOVASCULAR RISK FACTORS.  SOME CLINICIANS RECOMMEND CARDIAC EVALUATION TO EXCLUDE UNRECOGNIZED CARDIOVASCULAR DISEASE PRIOR TO USE OF SUMATRIPTAN OR OTHER TRIPTANS IN PATIENTS WHO HAVE TWO OR MORE CARDIOVASCULAR RISK FACTORS.
• MAIN ADVANTAGES ARE GOOD EFFICACY, A LONG SAFETY RECORD FOR USE AND MULTIPLE FORMULATIONS TO CHOOSE (EG. TABLETS, NASAL SPRAYS, INJECTABLES). 
• MAIN DISADVANTAGES ARE A HIGHER INCIDENCE OF SIDE EFFECTS AND THE POTENTIAL NEED TO SCREEN THOSE WITH MIGRAINE FOR CARDIOVASCULAR OR OTHER VASCULAR RISK PRIOR TO USE OF THE TRIPTANS. ANOTHER DISADVANTAGE IS THE FACT THAT MANY PATIENTS ARE “NEEDLE PHOBIC”.
• MANY INSURANCE PLANS REQUIRE THAT THOSE WITH MIGRAINE “TRY AND FAIL” 1-2 TRIPTANS PRIOR TO USING OTHER NEWER ACUTE MEDICATIONS (E.G., GEPANTS, DITANS AND SOME OLDER AGENTS SUCH AS ERGOTS).  

PRECAUTIONS AND RISKS:

• DO NOT USE IN THE SETTING OF CORONARY ARTERY DISEASE, UNSTABLE ANGINA, HX OF STROKE, BASILAR TYPE OR HEMIPLEGIC MIGRAINE, UNCONTROLLED HYPERTENSION, VASCULITIDES, INCLUDING ISCHEMIC BOWEL DISEASE.
• LIMIT USE TO 10 OR FEWER DAYS PER MONTH TO PREVENT MEDICATION OVERUSE HEADACHE.

CONTRAINDICATIONS:

• ARRHYTHMIAS ASSOCIATED WITH CARDIAC ACCESSORY CONDUCTION PATHWAY DISORDERS, INCLUDING WOLFF-PARKINSON-WHITE SYNDROME
• CONCOMITANT ADMINISTRATION OF MAO-A INHIBITORS OR USE WITHIN 2 WEEKS OF DISCONTINUATION OF MAO-A INHIBITOR THERAPY
• CONCOMITANT USE OF ERGOTAMINE-CONTAINING OR ERGOT-TYPE MEDICATION (E.G., DIHYDROERGOTAMINE, METHYSERGIDE) WITHIN 24 HOURS
• CONCOMITANT USE WITH A TRIPTAN OR ERGOT WITHIN 24 HOURS
• CORONARY ARTERY VASOSPASM, INCLUDING PRINZMETAL’S ANGINA, OR OTHER SIGNIFICANT UNDERLYING CARDIOVASCULAR DISEASE
• HISTORY OF HEMIPLEGIC OR BASILAR-TYPE MIGRAINE
• HISTORY OF STROKE OR TRANSIENT ISCHEMIC ATTACK
• HYPERSENSITIVITY TO SUMATRIPTAN OR ANY OF ITS COMPONENTS
• ISCHEMIC BOWEL DISEASE
• ISCHEMIC CORONARY ARTERY DISEASE (ANGINA PECTORIS, HISTORY OF MYOCARDIAL INFARCTION, OR DOCUMENTED SILENT ISCHEMIA)
• PERIPHERAL VASCULAR DISEASE
• SEVERE HEPATIC IMPAIRMENT
• UNCONTROLLED HYPERTENSION

PREGNANCY AND BREAST-FEEDING:

• CLICK IMITREX® AND NAVIGATE TO #8 USE IN SPECIFIC POPULATIONS (8.1 & 8.2)
• CLICK SUMAVEL DOSE PRO® AND NAVIGATE TO #8 USE IN SPECIFIC POPULATIONS (8.1 & 8.2)
• CLICK ZEMBRACE SYMTOUCH® AND NAVIGATE TO #8 USE IN SPECIFIC POPULATIONS (8.1 & 8.2)

COMMON DRUG INTERACTIONS:  

• DO NOT USE WITHIN 24 HOURS OF ANOTHER TRIPTAN OR ERGOTAMINE
• PHARMACISTS FREQUENTLY REPORT A DRUG INTERACTION BETWEEN TRIPTANS AND SERONTONERGIC ANTI-DEPRESSANTS BECAUSE OF THE RISK OF SEROTONIN SYNDROME.  HOWEVER, THIS IS FELT TO BE A THEORETICAL RISK. SUFFICIENT EVIDENCE TO SUPPORT THE CONTENTION THAT COMBINED USE OF TRIPTANS AND SEROTONERGIC ANTI-DEPRESSANTS IS UNSAFE HAS NOT BEEN ESTABLISHED. THIS IS REFLECTED IN A POSITION STATEMENT FROM THE AMERICAN HEADACHE SOCIETY (EVANS R. HEADACHE 2010; 50: 1089-99) THEREFORE, HEADACHE PHYSICIANS COMMONLY CO-ADMINISTER ANTIDEPRESSANTS AND TRIPTANS IN THE SAME PATIENT.  

COUNSELING TIPS:

• MAY BE USEFUL IN PATIENTS WITH NAUSEA/VOMITING OR PATIENTS WHO REQUIRE RAPID RELIEF.
• THE INJECTABLES HAVE THE FASTEST ONSET OF ACTION WHEN COMPARED TO TABLET AND NASAL FORMULATIONS OF SUMATRIPTAN, BUT GENERALLY HAVE A HIGHER INCIDENCE OF TRIPTAN SIDE EFFECTS (EG. PARESTHESIAS, NECK PAIN, CHEST PAIN, ETC.) THAN ORAL AND NASAL FORMULATIONS. 
• THE 6 MG DOSAGE IS THE STANDARD DOSAGE FOR SUMATRIPTAN INJECTABLES; HOWEVER, THE 3 MG AND 4 MG DOSAGES HAVE A LOWER SIDE EFFECTS PROFILE AND GOOD EFFICACY. 

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