Sumatriptan

Sumatriptan is a prescription medication used to treat migraine headaches once they have started. Sumatriptan injection is also used to treat cluster headaches in adults. Sumatriptan belongs to a group of drugs called serotonin receptor agonists or "triptans", which relieve pain by narrowing blood vessels around the brain.

This medication comes in tablet and nasal spray and is taken at the first sign of a migraine headache.

Sumatriptan is also available as an injectable form to be injected under the skin. 

Sumatriptan also comes as a device that uses your own breath to deliver the medicine into your nose.

Sumatriptan also comes in a skin patch form and is applied at the onset of a migraine headache.  

Common side effects of sumatriptan include tingling or numbness in fingers or toes, weakness, tiredness. Sumatriptan can cause drowsiness. Do not drive a car or operate machinery if you have these symptoms.

Sumatriptan is a prescription medication used to treat migraine headaches once they have started, with or without aura.

Sumatriptan injection is also used to treat cluster headaches in adults.

This medication may be prescribed for other uses.

Sumatriptan may be found in some form under the following brand names:

• Alsuma

• Imitrex

• Onzetra Xsail

• Sumavel DosePro

• Tosymra

• Treximet

• Zecuity

• Zembrace SymTouch

Sumatriptan may cause serious side effects. See “Drug Precautions”.

The most common side effects of sumatriptan tablets include:

• tingling or numbness in your fingers or toes
• dizziness
• warm, hot, burning feeling to your face (flushing)
• feeling weak, drowsy, or tired

The most common side effects of sumatriptan nasal spray include:

• dizziness
• warm, hot, burning feeling to your face (flushing)
• discomfort of your neck, throat, or nose
• unusual or bad taste in your mouth
• feeling weak, drowsy, or tired
• sensitivity to loud noises

The most common side effects of sumatriptan injection include:

• injection site reactions such as redness, pain, or swelling
• tingling or numbness in your fingers or toes
• dizziness
• warm, hot, burning feeling to your face (flushing)
• discomfort or stiffness in your neck
• feeling weak, drowsy, or tired

The most common side effects of sumatriptan inhalation device include:

• abnormal taste (metallic taste)
• nasal discomfort
• rhinorrhea (runny nose)
• rhinitis (stuffy nose)

The most common side effects of sumatriptan patch include:

• pain, itching, tingling, warmth, discomfort, or a change in the skin color at the application site.
• redness after removal of the patch, This redness will usually go away after 24 hours. 

This is not a complete list of sumatriptan side effects. Ask your doctor or pharmacist for more information.

Tell your healthcare provider if you have any side effect that bothers you or that does not go away.

These are not all the possible side effects of sumatriptan. For more information, ask your healthcare provider or pharmacist.

Tell your healthcare provider about all the medicines you take, including prescription and nonprescription medicines, vitamins, and herbal supplements.

Sumatriptan and other medicines may affect each other, causing side effects.

Especially tell your healthcare provider if you take:

• selective serotonin reuptake inhibitors (SSRIs) such as escitalopram (Lexapro), sertraline (Zoloft), citalopram (Celexa), paroxetine (Paxil), fluoxetine (Prozac, Sarafem), and fluvoxamine (Luvox)
• serotonin-norepinephrine reuptake inhibitors (SNRIs) such as duloxetine (Cymbalta) and venlafaxine (Effexor)
• monoamine oxidase inhibitors (MAOIs) such as tranylcypromine (Parnate), phenelzine (Nardil), selegiline (Eldepryl, Zelapar), isocarboxazid (Marplan), and rasagiline (Azilect)
• other ergot-containing medications such as dihydroergotamine (D.H.E. 45, MIGRANAL) or methysergide
• other triptans such as sumatriptan (Imitrex, Treximet), eletriptan (Relpax), almotriptan (Axert), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), and zolmitriptan (Zomig)

Ask your healthcare provider or pharmacist for a list of these medicines if you are not sure.

Know the medicines you take. Keep a list of them to show your healthcare provider or pharmacist when you get a new medicine.

Sumatriptan can cause serious side effects, including:

Changes in color or sensation in your fingers and toes (Raynaud’s syndrome)

Stomach and intestinal problems (gastrointestinal and colonic ischemic events). Symptoms of gastrointestinal and colonic ischemic events include:

• sudden or severe stomach pain
• stomach pain after meals
• weight loss
• nausea or vomiting
• constipation or diarrhea
• bloody diarrhea
• fever

Problems with blood circulation to your legs and feet (peripheral vascular ischemia). Symptoms of peripheral vascular ischemia include:

• cramping and pain in your legs or hips
• feeling of heaviness or tightness in your leg muscles
• burning or aching pain in your feet or toes while resting
• numbness, tingling, or weakness in your legs
• cold feeling or color changes in 1 or both legs or feet

Serious allergic reactions (symptoms include hives; tongue, mouth, lip, or throat swelling; problems breathing)

Heart attack and other heart problems. Heart problems may lead to death. Stop taking sumatriptan and get emergency medical help right away if you have any of the following symptoms of a heart attack:

• discomfort in the center of your chest that lasts for more than a few minutes, or that goes away and comes back
• chest pain or chest discomfort that feels like heavy pressure, squeezing, or fullness
• pain or discomfort in your arms, back, neck, jaw, or stomach
• shortness of breath with or without chest discomfort
• breaking out in a cold sweat
• nausea or vomiting
• feeling lightheaded

Sumatriptan is not for people with risk factors for heart disease unless a heart exam is done and shows no problem. You have a higher risk for heart disease if you:

• have high blood pressure
• have high cholesterol levels
• smoke
• are overweight
• have diabetes
• have a family history of heart disease
• are a female who has gone through menopause
• are a male over age 40

Serotonin syndrome. Serotonin syndrome is a serious and life-threatening problem that can happen in people taking sumatriptan, especially if sumatriptan is used with anti-depressant medicines called selective serotonin reuptake inhibitors (SSRIs) or selective norepinephrine reuptake inhibitors (SNRIs). Ask your healthcare provider or pharmacist for a list of these medicines if you are not sure. Call your healthcare provider right away if you have any of the following symptoms of serotonin syndrome:

• mental changes such as seeing things that are not there (hallucinations), agitation, or coma
• fast heartbeat
• changes in blood pressure
• high body temperature
• tight muscles
• trouble walking
• nausea, vomiting, or diarrhea

Medication overuse headaches. Some people who take/use too much sumatriptan may have worse headaches (medication overuse headache). If your headaches get worse, your healthcare provider may decide to stop your treatment with sumatriptan.

Seizures. Seizures have happened in people taking sumatriptan who have never had seizures before. Talk with your healthcare provider about your chance of having seizures while you take sumatriptan.

Serious side effects have been reported with the patch form of sumatriptan including the following:

• Risk of injury during magnetic resonance imaging (MRI) procedure. Sumatriptan patch contains metal parts and must be removed before an MRI procedure.
• Allergic contact dermatitis. Use of sumatriptan patch may lead to allergic contact dermatitis (ACD). Consult with your physician about your risk for developing ACD and if you have ever had any serious allergic skin reactions in the past before starting treatment with sumatriptan patch.

Do not take sumatriptan if you have:

• heart problems or a history of heart problems
• narrowing of blood vessels to your legs, arms, stomach, or kidney (peripheral vascular disease)
• uncontrolled high blood pressure
• severe liver problems
• hemiplegic migraines or basilar migraines. If you are not sure if you have these types of migraines, ask your healthcare provider.
• had a stroke, transient ischemic attacks (TIAs), or problems with your blood circulation
• taken any of the following medicines in the last 24 hours:
  • almotriptan (Axert)
  • eletriptan (Relpax)
  • frovatriptan (Frova)
  • naratriptan (Amerge)
  • rizatriptan (Maxalt, Maxalt-MLT)
  • sumatriptan and naproxen (Treximet)
  • ergotamines (Cafergot, Ergomar, Migergot)
  • dihydroergotamine (D.H.E. 45, Migranal)
• an allergy to sumatriptan or any of the ingredients in sumatriptan. 

Sumatriptan can cause dizziness, weakness, or drowsiness. If you have these symptoms, do not drive a car, use machinery, or do anything where you need to be alert.

Medicines can interact with certain foods. In some cases, this may be harmful and your doctor may advise you to avoid certain foods. In the case of sumatriptan, there are no specific foods that you must exclude from your diet when receiving sumatriptan.

Before you take sumatriptan, tell your healthcare provider about all of your medical conditions, including if you:

• are allergic to sumatriptan
• have high blood pressure
• have high cholesterol
• have diabetes
• smoke
• are overweight
• are a female who has gone through menopause
• have heart disease or a family history of heart disease or stroke
• have liver problems
• have ischemic bowel disease
• have ever had an allergic skin reaction to a medication product or food
• have had epilepsy or seizures
• are not using effective birth control
• are pregnant or plan to become pregnant
• become pregnant while taking sumatriptan
• are breastfeeding or plan to breastfeed

Tell your healthcare provider about all the medicines you take, including prescription and nonprescription medicines, vitamins, and herbal supplements.

Tell your doctor if you are pregnant or plan to become pregnant.

The FDA categorizes medications based on safety for use during pregnancy. Five categories - A, B, C, D, and X, are used to classify the possible risks to an unborn baby when a medication is taken during pregnancy.

Sumatriptan falls into category C. In animal studies, pregnant animals were given this medication and had some babies born with problems. No well-controlled studies have been done in humans. Therefore, this medication may be used if the potential benefits to the mother outweigh the potential risks to the unborn child.

Tell your healthcare provider if you are breastfeeding or plan to breastfeed.

Sumatriptan may pass into your breast milk and may harm your baby. Talk with your healthcare provider about the best way to feed your baby if you take sumatriptan.

Infant exposure to sumatriptan can be minimized by avoiding breastfeeding for 12 hours after treatment with sumatriptan tablets and nasal spray.

Because many medications can cross into human milk and because of the possibility for serious adverse reactions in nursing infants with use of this medication, a choice should be made whether to stop nursing or stop the use of this medication. Your doctor and you will decide if the benefits outweigh the risk of using sumatriptan.

• Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand.

If your headache comes back after the first dose, ask your doctor if you can administer another dose. 

• Certain people should take their first dose of sumatriptan in their healthcare provider’s office or in another medical setting. Ask your healthcare provider if you should take your first dose in a medical setting.
• Take sumatriptan exactly as your healthcare provider tells you to take it.Do not take more or less of it or take it more often than prescribed by your doctor.
• Your healthcare provider may change your dose. Do not change your dose without first talking to your healthcare provider.

Sumatriptan tablets:

• Take sumatriptan tablets with water or other liquids.
• If you do not get any relief after your first sumatriptan tablet, do not take a second tablet without first talking with your healthcare provider.
• If your headache comes back or you only get some relief from your headache, you can take a second tablet 2 hours after the first tablet.
• Do not take more than a total of 200 mg of sumatriptan tablets in a 24‑hour period.
• Some people who take too many sumatriptan tablets may have worse headaches (medication overuse headache). If your headaches get worse, your healthcare provider may decide to stop your treatment with sumatriptan.

Sumatriptan nasal spray:

• Certain people should take their first dose of sumatriptan nasal spray in their healthcare provider’s office or in another medical setting. Ask your healthcare provider if you should take your first dose in a medical setting.
• Use sumatriptan nasal spray exactly as your healthcare provider tells you to use it.
• Your healthcare provider may change your dose. Do not change your dose without first talking with your healthcare provider.
• If you do not get any relief after your first nasal spray, do not use a second nasal spray without first talking with your healthcare provider.
• If your headache comes back after the first nasal spray or you only get some relief from your headache, you can use a second nasal spray 2 hours after the first nasal spray.
• Do not take more than a total of 40 mg of sumatriptan nasal spray in a 24‑hour period.
• It is not known how using sumatriptan nasal spray for a long time affects the nose and throat.
• Some people who use too much sumatriptan nasal spray may have worse headaches (medication overuse headache). If your headaches get worse, your healthcare provider may decide to stop your treatment with sumatriptan nasal spray.

Sumatriptan injection:

Sumatriptan injection (Alsuma, Imitrex, Zembrace SymTouch, and Sumavel DosePro) comes in an autoinjection device so that you can self-inject this medication under the skin. Do not inject the medicine into a vein or muscle. Make sure you ask your doctor or pharmacist to show you how to load the injector and administer the medication as well as where to inject the medication. 

For adults, the usual dose is a single injection given just below the skin. You should give an injection as soon as the symptoms of your migraine start, but it may be given at any time during an attack.

Note: Make sure you discuss with your doctor about what to do next if you did not get relief after the first injection. Your doctor will let you know if you can administer a second injection. 

• Alsuma injection: You can take a second injection 1 hour after the first injection, but not sooner, if your headache came back after your first injection. Do not take more than 2 doses of Alsuma in 24 hours.
• Imitrex Injection: Do not give more than two 6-mg doses in any 24-hour period. Allow at least 1 hour between each dose.
• Zembrace SymTouch Injection: You may give a second injection if your migraine symptoms come back. Do not give more than four 3-mg doses in any 24-hour period. Allow at least 1 hour between each dose.
• Sumavel DosePro injection: You may use a second dose of Sumavel DosePro or 1 dose of another sumatriptan medicine separated by at least 1 hour, but not sooner, if your headache came back after your first dose. Do not use more than 2 doses of 6 mg or 3 doses of 4 mg Sumavel DosePro in a 24-hour period.

Sumatriptan inhalation device:

• Sumatriptan comes as a device that uses your own breath to deliver sumatriptan into your nose and is administered after a migraine headache has started.
• Administer sumatriptan exactly as prescribed.

Sumatriptan patch:

Use sumatriptan patch exactly as prescribed.

• Apply 1 sumatriptan patch to your upper arm or thigh at the onset of a migraine headache.
• Do not apply patch to other areas of your body. Talk to your healthcare provider if you are not sure where to apply patch.
• If your headache comes back or you only get some relief from your headache, you may apply a second sumatriptan patch to your other arm or thigh, no sooner than 2 hours after the activation of the previously applied sumatriptan.  
• DO NOT apply more than 2 sumatriptan patches in a 24 hour period.
• Do not bathe, shower or swim while wearing sumatriptan patch.
• Do not have a Magnetic Resonance Imaging (MRI) while wearing sumatriptan patch.
• Remove sumatriptan patch if you have a painful burning sensation during use.
• Upon removal of sumatriptan patch, most patients experience some skin redness under the patch, which usually disappears within 24 hours.

Apply and use sumatriptan exactly as prescribed by your physician. You may refer to the following section for additional information:

Choosing an application site: 

• Choose an application site on your upper arm or thigh. Do not apply sumatriptan patch to any other body parts.
• Choose an area of skin that is dry, clean and relatively hair free.
• Do not apply sumatriptan patch over skin that is red or irritated. The skin should be free of redness and irritation for at least 3 days prior to application.
• Do not apply sumatriptan patch over scars, tattoos, scratches, burns, abrasions, or broken skin.

Applying sumatriptan patch:

1. Remove sumatriptan patch from its packaging by folding and tearing from the notch at the corner of the clear pouch. Sumatriptan patch should not be cut. Do not use sumatriptan patch if the clear pouch is torn or damaged.
2. To apply the sumatriptan patch you must pull the 2 foil tabs. Place sumatriptan patch on a flat surface with the foil packets facing up. While holding the package, pull both foil tabs out, 1 at a time, and throw the foil tabs away in the trash. You must apply and activate sumatriptan patch within 15 minutes of completing this step. 
3. Sumatriptan patch has 2 foil packets that each contain a white medication pad that must be properly attached to the sumatriptan patch before use. To transfer and attach the medication pads to the sumatriptan patch use 2 fingers and firmly press and rub each foil packet, tracing the green arrow 3 times around. 
4. Unfold the orange flap and lift open the package. Slowly peel the first part of the Zecuity back from the silver liner. After checking to make sure that both white medication pads are securely attached, peel the Zecuity completely away from the liner. The sumatriptan patch will not work properly if both medication pads are not attached.
5. Apply sumatriptan patch to your upper arm or thigh and activate it by pressing the button to turn it on. The button will blink and then turn solid red as it releases the medicine. If the light does not turn solid red or goes off within the first 15 minutes of application this means no medicine is being delivered. (If this does occur, then the system should be gently removed and thrown away. You can immediately apply a new system to a different application site.)
6. Wear the patch for 4 hours or until the red light goes off. If the red light turns off before 4 hours, the patch has stopped delivering your medicine and should be gently removed and thrown away. 
7. If you still have migraine pain, another sumatriptan patch can be applied to a different application site.
8. You may feel a slight tingling or a mild burning sensation within 30 seconds of activating the sumatriptan patch after pressing the button.
9. If sumatriptan patch begins to peel off, the patch may be taped down with medical tape.

Removal of sumatriptan patch:

• Slowly remove sumatriptan patch to minimize skin irritation. Gently clean the area with mild soap and water to remove any medicine that might be left on the skin.

• Sumatriptan patch contains lithium-manganese dioxide batteries. Talk to your pharmacist or healthcare provider about how to follow state and local regulations when throwing away the patch. 

• After use, fold your used sumatriptan patch so the adhesive side sticks to itself and safely throw it away.

• Keep sumatriptan patch out of the reach of children and pets.     

If you take too much sumatriptan, call your healthcare provider or go to the nearest hospital emergency room right away.

Write down when you have headaches and when you take sumatriptan so you can talk with your healthcare provider about how sumatriptan is working for you.

Take sumatriptan exactly as prescribed. Follow the directions on your prescription label carefully.

The maximum daily dose of sumatriptan tablets is 200 mg.

The maximum daily dose of sumatriptan nasal spray is 40 mg.

Onzetra Xsail: The recommended dose of sumatriptan (Onzetra Xsail) for the treatment of migraines is 22 mg, administered by use of one nosepiece (11 mg) in each nostril. The maximum dose in a 24-hour period should not exceed two doses (44 mg) separated by at least 2 hours.

Alsuma Injection: The recommended dose in adults of sumatriptan (Alsuma) injection is 6 mg injected subcutaneously (under the skin). The maximum dose that may be given in 24 hours is two 6 mg injections separated by at least one hour.

Imitrex Injection: The recommended dose in adults of sumatriptan (Imitrex) injection is 6 mg injected subcutaneously (under the skin). The maximum dose that may be given in 24 hours is two 6 mg injections separated by at least one hour.

Zembrace SymTouch Injection: The recommended dose in adults of sumatriptan (Zembrace SymTouch) injection is 3 mg injected subcutaneously (under the skin). The maximum dose that may be given in 24 hours is four 3 mg injections separated by at least one hour.

Zecuity Patch: The recommended dose of sumatriptan (Zecuity) patch to stop migraine headaches in adults, with or without a preceding aura, after they've already started is one patch applied to the skin at the onset of a migraine headache and worn for at least four hours.

Sumavel DosePro Injection:

• The recommended dose of sumatriptan (Sumavel DosePro injection) to stop migraine headaches in adults is 4 mg or 6 mg injected subcutaneously (under the skin). 
• The recommended dose of sumatriptan (Sumavel DosePro injection) to treat cluster headaches in adults is 6 mg. 

The maximum dose that may be given in 24 hours is 12 mg. Separate doses by at least 1 hour. 

If you have taken more sumatriptan than has been prescribed for you, contact either your doctor, hospital emergency department, or your local Poison Control Center.

Sumatriptan injection (Alsuma, Imitrex, Zembrace SymTouch):

• Store sumatriptan between 36°F to 86°F (2°C to 30°C).
• Store your medicine away from light.
• Keep your medicine in the packaging or carrying case provided with it.
• Remove the injection from the packaging or carrying case only when you need to give yourself an injection. 

Sumatriptan tablets:

• Store sumatriptan tablets between 36°F to 86°F (2°C to 30°C).

Sumatriptan nasal spray:

• Store sumatriptan between 36°F to 86°F (2°C to 30°C).
• Store your medicine away from light.

Sumatriptan inhalational device (Onzetra Xsail):

• Store at room temperature between 20°C to 25°C (68°F to 77°F). Do not store in the refrigerator or freezer.
• Use nosepiece immediately after removing from foil pouch.
• Discard used nosepieces in the trash
• Put the protective cover back on the blue device and store it for your next use
• Cleaning the reusable blue device is not necessary—if you do want to clean the blue device, please use a clean, dry, lint-free cloth to wipe the mouthpiece between uses
• Do not wash the device
• Avoid contact with any liquids
• Remember to store the blue device and unopened pouches in a clean, cool, and dry place
• Be sure to check the expiration date for each nosepiece at each use

Sumatriptan patch (Zecuity):

• Store at room temperature, between 20°C to 25°C (68°F to 77°F)
• Do not store this medication in the refrigerator or freezer.
• After use, fold used patch so the adhesive side sticks to itself and safely discard away from children and pets
• Sumatriptan patch contains lithium-manganese dioxide batteries; dispose in accordance with state and local regulations

Sumavel DosePro injection:

• Store Sumavel DosePro between 68 °F to 77 °F (20 °C to 25 °C).
• Do not freeze.
• Protect from light.
• Keep Sumavel DosePro and all medicines out of the reach of children.