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sumatriptan succinate

(sue mah trip' tan)


Imitrex

Pregnancy Category C

Drug classes
Antimigraine drug (triptan)
Serotonin-selective agonist

Therapeutic actions
Binds to serotonin receptors to cause vascular constrictive effects on cranial blood
vessels, causing the relief of migraine in selective patients.

Indications
• Treatment of acute migraine attacks with or without aura
• SC: Acute treatment of cluster headaches

Contraindications and cautions


• Contraindicated with allergy to sumatriptan, cerebrovascular or peripheral
vascular syndromes, severe hepatic impairment, MAOIs, uncontrolled
hypertension, hemiplegic migraine, pregnancy, coronary artery disease.
• Use cautiously with the elderly, lactation, renal function impairment.

Available forms
Tablets—25, 50, 100 mg; injection—12 mg/mL; nasal spray—5, 20 mg

Dosages
ADULTS
Oral
25, 50, or 100 mg; additional doses may be repeated in > 2 hr; up to a maximum of
200 mg/day.
SC
6 mg, may be repeated in 1 hr. Maximum: 12 mg/24 hr.
Intranasal
5, 10, or 20 mg, may be repeated after 2 hr. Maximum: 40 mg/24 hr.
PEDIATRIC PATIENTS
Safety and efficacy not established.
PATIENTS WITH HEPATIC IMPAIRMENT
Maximum single dose, 50 mg.

Pharmacokinetics
Route Onset Peak
SC Varies 5–20 min
Oral 60–90 min 2–4 hr
Injection Rapid 90 min

Metabolism: Hepatic; T1/2: 115 min


Distribution: Crosses placenta; enters breast milk
Excretion: Urine

Adverse effects
• CNS: Dizziness, vertigo, headache, anxiety, malaise or fatigue, weakness,
myalgia
• CV: Blood pressure alterations, tightness or pressure in chest
• GI: Abdominal discomfort, dysphagia
• Local: Injection site discomfort, nose and throat discomfort (nasal spray)
• Other: Tingling, warm or hot sensations, burning sensation, feeling of heaviness,
pressure sensation, numbness, feeling of tightness, feeling strange, cold sensation
Nasal spray
• GI: Bad taste, nausea

Interactions
Drug-drug
• Prolonged vasoactive reactions with ergot-containing drugs (should not be used
within 24 hr of each other)
• Increased serum levels and toxicity of sumatriptan with MAOIs; avoid this
combination and for 2 wk after MAOI discontinuation
Drug-alternative therapy
• Increased risk of severe reaction if combined with St. John's wort therapy

Nursing considerations
Assessment
• History: Allergy to sumatriptan; active CAD; uncontrolled hypertension;
hemiplegic migraine; pregnancy, lactation
• Physical: Skin color and lesions; orientation, reflexes, peripheral sensation; P,
BP; renal and liver function tests

Interventions
• Administer to relieve acute migraine, not as a prophylactic measure.
• Administer as SC injection just below the skin as soon as possible after symptoms
begin.
• Repeat injection only after 1 hr if relief is not obtained; only two injections may
be given each 24 hr.
• Administer PO with fluids; may repeat in 2 hr if no relief.
• Repeat nasal spray after 2 hr if headache returns or does not respond.
• Monitor BP of patients with possible CAD; discontinue at any sign of angina,
prolonged high BP.

Teaching points
• Learn to use the autoinjector; injection may be repeated only after 1 hr if relief is
not obtained; do not administer more than two injections in 24 hr.
• Inject just below the skin as soon as possible after onset of migraine; this drug is
for an acute attack only, not for use to prevent attacks.
• Administer nasal spray as a single dose; repeat if needed only after 2 hr.
• Take oral drug with fluids, may be repeated in 2 hr if no relief or return of
headache.
• This drug should not be taken during pregnancy; if you suspect that you are
pregnant, contact physician and refrain from using drug.
• Contact physician immediately if you experience severe or continuous chest pain
or pressure.
• These side effects may occur: Dizziness, drowsiness (avoid driving or the use of
dangerous machinery); numbness, tingling, feelings of tightness or pressure.
• Report feelings of heat, flushing, tiredness, feelings of sickness, swelling of lips
or eyelids.

Adverse effects in Italic are most common; those in Bold are life-threatening.

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