Sumatriptan

What is Sumatriptan?

Sumatriptan is an oral medication used to treat migraines, relieving symptoms such as headache, pain, nausea, vomiting, and sensitivity to light and sound. They are prescribed where ordinary painkillers fail to relieve migraine symptoms.

How long do the effects of Sumatriptan last?

The effects of Sumatriptan depend on the severity of your migraine and your personal condition and response to treatment. If there is no improvement of your symptoms after taking Sumatriptan, do not take more without first speaking to a doctor. If your symptoms are only partially relieved, or if they return, you may take another dose at least 2 hours after the first. 

How does Sumatriptan work?

Sumatriptan belongs to a group of medicines known as serotonin receptor agonists, or triptans, which work by reversing the changes in the brain which cause migraines. Primarily, triptans affects the natural substance serotonin, reversing the widening of blood vessels that is thought to be the main cause of migraines. Sumatriptan is not a cure and will not prevent the occurence of future migraines. 

How effective is Sumatriptan?

The effectiveness of Sumatriptan differs from patient to patient. It is recommended to arrange a follow-up appointment with a doctor after beginning this treatment, to discuss its effectiveness and any side effects you may have experienced.

Inactive ingredients

The inactive ingredients in Sumatriptan are lactose monohydrate, hypromellose, microcrystalline cellulose, croscarmellose sodium, magnesium stearate, hypromellose, and titanium dioxide (E171). The 50 mg film-coated tablets also include triacetin and red iron oxide (E172).

Please Note: Different manufacturers of generic Sumatriptan could use different inactive ingredients in their drugs that those listed above.

Active ingredients

The active ingredient in Sumatriptan is sumatriptan.

Sumatriptan dosage

Your dosage will be decided by a doctor dependent on the severity of your symptoms and your response to treatment. The recommended dose for adults ages 18 to 65 is 1 x 50 mg tablet when you feel the symptoms of migraine coming on, which can be increased to 100 mg if necessary. Sumatriptan is not recommended for use in adults over the age of 65.

How to use Sumatriptan

Always use Sumatriptan as instructed by a doctor or pharmacist. Swallow one tablet whole with a glass of water as soon as you feel the symptoms of migraine coming on. Do not crush or chew the tablets. If your first dose has no effect, do not take another tablet without first consulting a doctor. If your symptoms are temporarily relieved but return later, it is possible to take another dose within 24 hours in some circumstances. Do not take two doses within 2 hours of each other, and do not exceed the maximum dose of 300 mg within 24 hours. If you take more Sumatriptan than you should, contact a doctor immediately. 

Sumatriptan side effects

Like all medicines, Sumatriptan can cause side effects in some patients. If you experience symptoms of a rare but severe allergic reaction, stop taking Sumatriptan and seek medical help immediately. Symptoms include skin rash such as red spots or hives, swelling of the eyelids, face or lips, sudden wheeziness, tightness of the chest or total collapse.

Common side effects, affecting up to 1 in 10 people, include:

• Drowsiness, dizziness, sensory disturbance
• Difficulty breathing
• Muscle pain
• Temporary increase in blood pressure
• Flushing
• Weakness, tiredness
• Nausea or vomiting
• Pain, sensation of heat or cold, pressure, tightness or heaviness. These symptoms are generally temporary and can occur in any part of the body.

The frequency of the following side effects can not be estimated from the available data:

• Seizures, involuntary movement, tremor, nystagmus
• Visual disorders such as flickering, reduced vision, or loss of vision (this may be the result of the miraine itself)
• Changes in heartbeat, chest pain or heart attack
• Low blood pressure, Raynaud’s phenomenon
• Inflammation of the colon, with pain in the lower left side of the abdomen and/or bloody diarrhoea
• Neck stiffness
• Minor disturbances in liver function tests
• Diarrhoea
• Anxiety
• Excessive sweating
• Joint pain

Contraindications

Do NOT take Sumatriptan if:

• You are allergic to sumatriptan or any of the other ingredients in this medication
• You have a heart problem such as a narrowing of the arteries (ischaemic heart disease), chest pain (angina), or have had a heart attack in the past
• You have had a stroke or a mini-stroke (TIA or a transient ischaemic attack)
• You have blood circulation problems in the legs causing cramp-like pain when you walk (peripheral vascular disease)
• You have high blood pressure or your blood pressure remains high despite medication
• You have severely reduced liver function

Before using Sumatriptan, tell your doctor if:

• You have symptoms indicating cardiac disease, including chest pain or feeling of pressure in the chest area which may be radiating to your neck
• You have an intolerance to some sugars
• You have reduced liver or kidney function
• You have a history of fits (seizures), or if you have other conditions which might make it more likely that you’ll have a fit, including head injury and alcoholism
• You are allergic to sulfonamide
• You are a heavy smoker or are using nicotine replacement therapy, in particular if you are a man over the age of 40 or a woman who has been through menopause

Drug interactions

Before taking Sumatriptan, tell your doctor or pharmacist if you are taking any other medications, including those purchased over the counter without a prescription. Some medicines may influence the effects of Sumatriptan, and vice versa:

• Ergotamine or its derivatives, used to treat migraines. If you have taken a product containing Ergotamine, wait at least 24 hours before taking Sumatriptan. After taking Sumatriptan, wait at least 6 hours before taking a product containing ergotamine.
• Do not take Sumatriptan if you have taken MAO inhibitor in the past 2 weeks. This includes moclobemide for depression or selegiline for the treatment of Parkinson’s disease.
• Using Sumatriptan with SSRIs and SNRIs for depression can cause serotonin syndrome, with symptoms such as restlessness, confusion, sweating, hallucinations, increased reflexes, muscle spasms, shivering, increased heartbeat, and shaking.
• Taking Sumatriptan with herbal remedies containing St. John’s Wort (Hypericum perforatum) may make side effects more likely.

Driving whilst taking Sumatriptan

Migraines may cause alterations to vision, dizziness and sleepiness, and Sumatriptan itself can cause drowsiness. This should be taken into account before driving or using heavy machinery. If you experience these symptoms or side effects, do not drive or operate heavy machinery until the sensation has passed.

Sumatriptan and pregnancy

If you are pregnant, planning on becoming pregnant, or breastfeeding, speak to a doctor before using Sumatriptan.

Sumatriptan and alcohol

You should not drink alcohol when taking Sumatriptan, as this can increase the likelihood of side effects such as drowsiness, dizziness and flushing. Alcohol is also likely to worsen the symptoms of migraine.

Can I take Sumatriptan with over the counter painkillers and headache treatments?

Sumatriptan can be taken in combination with over-the-counter painkillers such as paracetamol or ibuprofen to relieve the symptoms of migraine. However, you should check with a pharmacist before using Sumatriptan with over-the-counter treatments specifically designed for treating migraines.

Imigran Nasal Spray vs Sumatriptan

Imigran Nasal Spray and Sumatriptan tablets contain the same active ingredient, sumatriptan, and work in the same way to relieve the symptom of migraine. Both begin to work in around 30 minutes and should be used as soon as the symptoms of migraine become apparent. Imigran Nasal spray is a good alternative for people who struggle to swallow tablets, but should be used at a lower dose of 1 x 20mg, or 1 x 20 mg spray into one nostril. The nasal spray and tablet options are considered to have a similar effectiveness, though the nasal spray is less likely to have adverse side effects.

Alternatives to Sumatriptan

Sumatriptan is the most commonly prescribed treatment for migraines, and is available in the form of a nasal spray under the name Imigran. Other triptans are also an option, including Frovatriptan and Naratriptan, which are thought to have longer-lasting effects. Anti-sickness medications, or anti-emetics, can also be prescribed, and work even if you do not experience nausea with your migraines. Combination medications containing both painkillers and anti-sickness medicines can be purchased over the counter with help from a pharmacist, and are effective for relieving mild symptoms. Regular painkillers such as paracetamol and ibuprofen can be used in combination with triptans to relieve the headache of migraines.

Using Sumatriptan with other migraine treatments

If Sumatriptan fails to relieve your symptoms, it is fine to take painkillers such as paracetamol, ibuprofen or aspirin. However, Sumatriptan should not be taken within 24 hour of ergotamine, dihydroergotamine, methysergide, or any other triptan-containing migraine treatment, including zolmitriptan, almotriptan, eletriptan, frovatriptan, rizatriptan, or naratriptan.

Is Sumatriptan ok for long term use?

Sumatriptan is recommended for intermittent treatment of migraines as they occur. While there is no evidence of dependency or adverse effects resulting from long term use, Sumatriptan should not be used daily or as prophylaxis against migraine.

Is Sumatriptan a painkiller?

Sumatriptan is a type of painkiller known as a serotonin receptor agonists, which are specifically used to treat migraines.

Is Sumatriptan prevention or a cure?

Sumatriptan is used to treat and relieve the symptoms of migraines as they occur. It will not prevent the occurence of migraines, or act as a cure.

Does Sumatriptan work for ocular migraines and migraines without headaches?

The symptoms of ocular migraines, also known as retinal migraines, include blind spots in the vision, bright or flashing lights, temporary vision loss, and light sensitivity. These symptoms are often accompanied by headache-like symptoms, in which case Sumatriptan can be used for relief. It is unusual to treat the symptoms of ocular migraines without headaches, as they do not usually last long. 

Sources

• Patient Information Leaflet  
• NHS > Migraines
• WebMD > Sumatriptan Succinate
• NCBI > Long Term Use of Sumatriptan
• Oregon Eye Specialists > Triggers and Treatments for Ocular Migraines