SumatriptanSumatriptan Succinate

About Sumatriptan

Sumatriptan binds to 5-HT1B and 5-HT1D serotonin receptors. It treats attacks, does not prevent them, and no sumatriptan-only product is approved for anyone under 18. Doses depend on the form, and a second dose waits at least 2 hours (1 hour for injections and Tosymra): tablets 25, 50 or 100 mg, up to 200 mg in 24 hours (single doses of at most 50 mg with mild to moderate liver impairment); generic nasal spray 5, 10 or 20 mg, up to 40 mg; Tosymra 10 mg, up to 30 mg; Onzetra Xsail 22 mg from two nosepieces, up to 44 mg; injections up to 6 mg (4 mg for migraine if side effects limit the dose), up to 12 mg; Zembrace 3 mg, up to 12 mg. The tablet and generic nasal spray labels say the safety of treating more than four headaches in 30 days has not been established.

Tingling, warm or cold sensations, dizziness, tiredness and pain or pressure in the chest, neck, throat or jaw are common; nasal forms often leave an unusual taste, and injections cause site reactions. Chest symptoms are usually not from the heart, but triptans can rarely cause heart attacks, dangerous rhythms, strokes and spasm of other blood vessels, so someone with several heart risk factors has a heart check first and may take the first dose under supervision. It must not be used with coronary artery disease or spasm, Wolff-Parkinson-White syndrome or similar rhythm disorders, a past stroke or TIA, hemiplegic or basilar migraine, peripheral vascular or ischemic bowel disease, uncontrolled high blood pressure, severe liver impairment, within 24 hours of another triptan or an ergot, or with or within 2 weeks of an MAO-A inhibitor. Other warnings cover serotonin syndrome, rare large rises in blood pressure, allergic reactions, seizures, and medication-overuse headache with use on 10 or more days a month.

Imitrex tablets and the STATdose pen are still marketed, the vial is not, and Imitrex nasal spray remains approved but has no current FDA drug listing or DailyMed label. Sumatriptan with naproxen (Treximet and generic 85/500 mg tablets) is a separate combination for adults and children 12 and older that also carries naproxen’s boxed warning on heart attack, stroke and stomach or intestinal bleeding. Pregnancy registry and other studies have not shown more birth defects than in the general population, and the Imitrex labels say not breastfeeding for 12 hours after a dose reduces a baby’s exposure.

Taking Sumatriptan

How to take it

Use it at the first sign of a migraine. Swallow tablets whole with liquid. For a nasal spray, blow your nose gently, then use one single-dose device in one nostril; Onzetra Xsail is blown in through a nosepiece in each nostril. Inject only under the skin. If the first dose does not help, call the prescriber before a second.

If you miss a dose

It is used only for an attack, so there is no schedule to miss.

Storage

At room temperature, away from heat and moisture (not in the bathroom), out of reach of children. Do not refrigerate or freeze Tosymra or Onzetra Xsail, or freeze Zembrace.

Interactions to know about

Not within 24 hours of another triptan or an ergot, or with or within 2 weeks of an MAO-A inhibitor, which raises its levels. SSRI, SNRI and tricyclic antidepressants can contribute to serotonin syndrome. Get emergency help for chest pain or pressure, shortness of breath, a fast or irregular heartbeat, or weakness or numbness in an arm or leg.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Sumatriptan differs from pharmacy to pharmacy

Generic tablets and vials have many makers, generic nasal sprays and autoinjectors fewer, and a pharmacist can substitute only a generic of the same form and strength. Tosymra, Onzetra Xsail and Zembrace are priced as brands, as is a prescription that names Imitrex and blocks substitution. Fills are often small and each carries a dispensing fee; the STATdose pen comes as a kit with the reusable pen or as refill cartridges.

Ways to pay less for Sumatriptan without insurance

• Ask for a generic of your form, and check that the prescription does not name a brand only.
• If your brand has no generic, ask the prescriber whether a generic form would suit you.
• If you already have the reusable STATdose pen, ask whether your refill can be cartridges only.
• If you treat attacks often, ask the prescriber whether a larger quantity per fill, within your monthly limit, suits you.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Sumatriptan

1. 1.When can I take a second dose, and what is the 24-hour limit for my form?
2. 2.Do my heart risk factors mean my first dose should be taken under supervision?
3. 3.Is it safe with my antidepressant or other medicines?
4. 4.How many days a month can I use it without risking rebound headaches?

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