Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

sumatriptan (Rx)Brand and Other Names:Imitrex, Imitrex Statdose, more...Sumavel DosePro, Alsuma, Zembrace SymTouch

 
 
 

Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

tablet

  • 25mg
  • 50mg
  • 100mg

injectable SC solution

  • 6mg/0.5mL vial (Imitrex)

prefilled SC syringe/cartridge

  • 3mg/0.5mL autoinjector (Zembrace SymTouch)
  • 4mg/0.5mL (Imitrex StatDosePen; Sumavel DosePro)
  • 6mg/0.5mL (Imitrex StatDosePen; Sumavel DosePro; Alsuma Autoinjector)

Migraine Headache

Tablet

  • 25 mg, 50 mg, or 100 mg PO (taken with fluids)
  • Not to exceed 100 mg/dose; additional doses q2hr PRN
  • Recommended maximum dose: 200 mg/day
  • See also combo with naproxen

Injection

  • 6 mg (0.5 mL) SC with autoinjector; may repeat in ≥1 hr
  • Not to exceed 12 mg SC q24hr
  • Dose may be reduced to 1-5 mg under certain circumstances; eg, adverse reactions

Cluster Headache

6 mg (0.5 mL) SC with autoinjector; may repeat in ≥1 hour

Not to exceed 12 mg SC q24hr

Dosing considerations

  • Dose may be reduced under certain circumstances; eg, adverse reactions

Dosage Modifications

Mild to moderate hepatic impairment: Oral not to exceed 50 mg/dose; no dosage adjustments necessary if administered SC (use with caution)

Severe hepatic impairment: Contraindicated

<18 years: Safety and efficacy not established

Use not recommended (higher incidence of adverse effects)

Next

Interactions

Interaction Checker

sumatriptan and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

            Sort by :  
             activity indicator 
            Previous
            Next

            Adverse Effects

            >10%

            Injection site reaction (≤86%)

            Paresthesia (5-14%)

            Dizziness (12%)

            Warm/hot sensation (11%)

            1-10%

            Chest discomfort/pressure/tightness (2-5%)

            Jaw or neck tightness (1-5%)

            Diaphoresis (2%)

            Burning sensation (7%)

            Cold sensation (1%)

            Dysphagia

            Sore throat (3%)

            Malaise (1%)

            Abdominal distress (1%)

            Frequency Not Defined

            Agitation

            Cardiac arrhythmia: V-fib/V-tach (rare)

            Dysuria

            Eye irritation

            Flushing

            MI and coronary artery vasospasm in patients with CAD risk factors (extremely rare)

            Nasal discomfort

            Palpitations

            Tingling

            Weakness

            Previous
            Next

            Warnings

            Contraindications

            Current/history of ischemic cardiac, cerebrovascular, or peripheral vascular syndromes (angina, MI, stroke, TIA, ischemic bowel disease)

            History of stroke, transient ischemic attack, or hemiplegic or basilar migraine

            History of coronary artery disease or coronary artery vasospasm

            Wolff-Parkinson-White syndrome or other cardiac accessory conduction pathway disorders

            Uncontrolled hypertension

            DO NOT use IV

            Within 2 weeks of MAO-A inhibitors

            Within 24 hours of another 5-HT1 receptor agonist or ergot-type medications

            Severe hepatic impairment

            Hypersensitivity

            Uncontrolled hypertension

            Cautions

            Use when clear diagnosis of migraine established

            Equally effective at any stage of migraine, although early use recommended

            Overuse of acute migraine drugs (eg, ergotamine, triptans, opioids, or combination of these drugs for ≥10 days/month) may lead to exacerbation of headache (medication overuse headache); detoxification may be necessary

            Binds to melanin, may cause toxicity to melanin-rich tissues on prolonged use

            Very rare reports of transient and permanent blindness and significant partial vision loss

            Serotonin syndrome may occur, particularly during combined use with SSRIs (eg, fluoxetine, paroxetine, sertraline, fluvoxamine, citalopram, escitalopram) or SNRIs (eg, venlafaxine, duloxetine); discontinue therapy if it occurs

            Cerebral/subarachnoid hemorrhage and stroke reported with 5-HT1 agonist administration; discontinue if it occurs

            Significant elevation of blood pressure, including hypertensive crisis, reported

            Not for administration to patients with risk factors for coronary artery disease

            Use caution in patients with history of seizure disorder or lowered seizure threshold

            May cause depression including dizziness, weakness, or drowsiness (infrequent); caution when operating heavy machinery

            Coronary artery vasospasm, transient ischemia, ventricular tachycardia/fibrillation, myocardial infarction, cardiac arrest and death reported with use 5HT1 agonists; perform cardiac evaluation in patients with multiple cardiovascular risk factors; evaluate for coronary artery disease in patients at high risk; discontinue therapy if arrhythmia occurs

            Use oral formulations with caution in patients with mild-to-moderate hepatic impairment if treatment necessary and advisable; presystemic clearance, when administered orally, is reduced in hepatic impairment and cause an increase in plasma concentrations; dose reduction recommended; when adminsitered parenterally (SC, intranasal), does not undergo first pass metabolism and may not cause increase in plasma concentrations

            Previous
            Next

            Pregnancy & Lactation

            Pregnancy category: C

            Embryolethality and blood vessel abnormalities observed with PO or IV doses in pregnant rabbits during organogenesis

            Lactation: Excreted in breast milk at very low levels (NLM TOXNET); minimize infant to potential exposure by avoiding breastfeeding for 8-12 hours after administration

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

            more...
            Previous
            Next

            Pharmacology

            Mechanism of Action

            Selective 5-HT1B and 5-HT1D receptor agonist in cranial arteries; elicits vasoconstrictive and anti-inflammatory effects; associated with antidromic neuronal transmission and relief of migraine headache

            Absorption

            Bioavailability: 15% (PO); 97% (SC)

            Onset: 10 min (SC); 30 min (PO)

            Duration: 9-24 hr (SC)

            Peak plasma time: 0.5-3 hr (PO); 5-20 minutes (SC)

            Peak plasma concentration: 18-51 ng/mL (PO); 55-108 ng/mL (SC, 6 mg dose)

            Distribution

            Protein bound: 14-21%

            Vd: 2.4 L/kg

            Metabolism

            Metabolized via hepatic MAO-A isoenzyme

            Elimination

            Half-life: 2-2.5 hr (PO); 115 min (IV)

            Renal clearance: 264 mL/min

            Total body clearance: 1176-1200 mL/min

            Excretion: Urine (60%); feces (40%)

            Previous
            Next

            Images

            Previous
            Next

            Formulary

            FormularyPatient Discounts

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
            Add or Remove Plans
            Plans for
            Select State:
            Non-Medicare PlansMedicare Plans

            Select a box to add or remove a plan.

            Select a class to view formulary status for similar drugs

            Additional Offers
            Email to Patient

            From:

            To:

            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Email Forms to Patient

            From:

            To:

            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Previous
             
             
             
            All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.