Sumatriptan

Sumatriptan is indicated for acute treatment of migraine with or without aura in adults. 

Limitations of Use:

• Use only if a clear diagnosis of migraine headache has been established.
• Not indicated for the prophylactic therapy of migraine attacks.
• Not indicated for the treatment of cluster headache.

Sumatriptan Nasal Spray is an aqueous suspension of microfine Sumatriptan BP 10 mg for topical administration to the nasal mucosa by means of a metering, atomizing spray pump. Sumatriptan binds with high affinity to human cloned 5 HT1B/1D receptors. Sumatriptan presumably exerts its therapeutic effects in the treatment of migraine headache through agonist effects at the 5 HT1B/1D receptors on intracranial blood vessels and sensory nerves of the trigeminal system, which result in cranial vessel constriction and inhibition of pro-inflammatory neuropeptide release.

Route of administration: Nasal

• Single-dose of 10 mg of nasal spray.
• The maximum dose in a 24 hour period: 30 mg; separate doses by at least one hour or as directed by the physician.

Use in children and adolescents: Sumatriptan is not recommended for use in patients younger than 18 years of age.

Administration

How to use the Nasal Spray-

• Shake the bottle gently and remove the dust cover.
• Hold the spray with your forefinger and middle finger on either side of the nozzle and your thumb underneath the bottle. Press down until a fine spray appears. If using for the first time or if you have not used it for a week or more, press the nasal applicator several times until a fine moist comes out from the container.
• Gently blow the nose to clear the nostrils.
• Close one nostril and carefully insert the nasal applicator into the open nostril. Tilt your head forward slightly and keep the spray upright. Breathe in through your nose and while breathing in, press the white-collar of nasal applicator firmly down once to release a spray.
• Breathe out through your mouth.
• Repeat the above steps in the same/ other nostril for consecutive doses.

Cleaning: The nasal spray should be cleaned at least once a week. The procedures are as follows-

• Remove the dust cover.
• Gently pull off the nasal applicator.
• Wash the applicator and dust cover in warm water.
• Shake off the excess water and leave to dry in a normal place. Avoid to apply additional heat.
• Gently push the applicator back on the top of the bottle and re-fix the dust cover.

With Medicine: Sumatriptan nasal spray is contraindicated with Ergot-Containing Drugs, Monoamine Oxidase-A Inhibitors, Other 5-HT1 Agonists and Selective Serotonin Reuptake Inhibitors/Serotonin Norepinephrine Reuptake Inhibitors.

With food and others: No interaction with foods.

• History of coronary artery disease or coronary vasospasm
• Wolff-Parkinson-White syndrome or other cardiac accessory conduction pathway disorders
• History of stroke, transient ischemic attack, or hemiplegic or basilar migraine
• Peripheral vascular disease
• Ischemic bowel disease
• Uncontrolled hypertension
• Recent (within 24 hours) use of another 5 HT1 agonist (e.g., another triptan) or of an ergotamine containing medication
• Concurrent or recent (past 2 weeks) use of monoamine oxidase A inhibitor
• Hypersensitivity to sumatriptan (angioedema and anaphylaxis seen)
• Severe hepatic impairment

Common side effects: Unusual or unpleasant taste in the mouth; pain, burning, numbness, or tingling in the nose or throat; runny or stuffy nose after using the nasal medicine.

Rare side effects: Anxiety, burning sensation, discomfort of the nasal cavity and throat, general feeling of illness or tiredness & vision changes.

There are no adequate and well-controlled studies in pregnant women and lactating mothers.

• Myocardial ischemia/infarction and Prinzmetal’s angina: Perform cardiac evaluation in patients with multiple cardiovascular risk factors
• Arrhythmias: Discontinue Sumatriptan if occurs
• Chest/throat/neck/jaw pain, tightness, pressure, or heaviness: Generally, not associated with Myocardial Ischemia; evaluate for coronary artery disease in patients at high risk
• Cerebral hemorrhage, subarachnoid hemorrhage, and stroke: Discontinue Sumatriptan if occurs
• Gastrointestinal ischemia and reactions, peripheral vasospastic reactions: Discontinue Sumatriptan if occurs
• Medication overuse headache: Detoxification may be necessary
• Serotonin syndrome: Discontinue Sumatriptan if occurs
• Increase in blood pressure: Hypertensive crisis can occur
• Hypersensitivity reactions: Angioedema and anaphylaxis can occur
• Seizures: Use with caution in patients with epilepsy or a lowered seizure threshold
• Local irritation: Burning and abnormal taste can occur

No specific data is available on the overdose of Sumatriptan 10 mg nasal spray.

5-HT Agonists.

Store between 20°C-25°C temperature. Do not store in the refrigerator or freezer. Do not test before use.