Names and pronunciation
(soo-ma-trip′tan) Imitrex, Imitrex STAT-Dose, Sumavel DosePro, Onzetra Xsail, Tosymra, Zembrance SymTouch
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Individual generic drug information
Extracted information for SUMAtriptan only.
(soo-ma-trip′tan) Imitrex, Imitrex STAT-Dose, Sumavel DosePro, Onzetra Xsail, Tosymra, Zembrance SymTouch
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Func. class.: Antimigraine agent
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Chem. class.: 5-HT1B/D receptor agonist, abortive agent, triptan
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Do not confuse: SUMAtriptan/somatropin
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ACTION: Binds selectively to the vas- cular 5-HT1B/D receptor subtype; exerts antimigraine effect; causes vasoconstric- tion in cranial arteries
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USES: Acute treatment of migraine with/without aura and cluster headache
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Extracted information for SUMAtriptan only.
CONTRAINDICATIONS: Angina pectoris, history of MI, documented silent ischemia, Prinzmetal’s angina, ischemic heart disease, IV use, concur- rent ergotamine-containing prepara- tions, uncontrolled hypertension, hyper- sensitivity, basilar or hemiplegic migraine Precautions: Pregnancy, breastfeeding, children <18 yr, geriatric patients, post- menopausal women, men >40 yr, risk factors for CAD, hypercholesterolemia, obesity, diabetes, impaired renal/hepatic function, overuse
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SIDE EFFECTS CNS: Tingling, hot sensation, burning, feeling of pressure, tightness, numb- ness, dizziness, sedation, headache, anxiety, fatigue, cold sensation CV: Flushing, MI, hypo/hypertension EENT: Throat, mouth, nasal discomfort; vision changes GI: Abdominal discomfort INTEG: Inj-site reaction, sweating MS: Weakness, neck stiffness, myalgia RESP: Chest tightness, pressure
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INTERACTIONS Increase: vasospastic effects: ergot, ergot derivatives Increase: serotonin syndrome—SSRIs, SNRIs, serotonin-receptor agonists, sibutramine Increase: SUMAtriptan effect—MAOIs Drug/Herb • Increase: serotonin syndrome: SAM-e, St. John’s wort
Source page 1242
Extracted information for SUMAtriptan only.
DOSAGE AND ROUTES • Adult: SUBCUT ≤6 mg; may repeat in 1 hr; max 12 mg/24 hr; PO 25 mg with fluids, if no relief in 2 hr, give another dose, max 200 mg/day; NASAL single dose of 5, 10, or 20 mg in 1 nostril, may repeat in 2 hr, max 40 mg/24 hr; 1 puff each nostril q2hr; nasal powder 11 mg in each nostril may repeat after 2 hr Hepatic dose • Adult: PO 25 mg; if no response after 2 hr, give ≤50 mg
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Available forms: Inj 4, 6 mg/0.5 mL; tabs 25, 50, 100 mg; nasal spray 5 mg/100 mcl-U; dose spray device 20 mg/100 mcl-U
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Administer: PO route • Swallow tabs whole; do not break, crush, or chew • Take tabs with fluids as soon as symp- toms appear; may take a 2nd dose >4 hr; max 200 mg/24 hr SUBCUT route • SUBCUT only just below the skin; avoid IM or IV administration; use only for ac- tual migraine attack • Give 1st dose supervised by medical staff to patients with coronary artery dis- ease or those at risk for CAD Nasal route • May give as 2 sprays of 5 mg in 1 nos- tril or 1 spray in each nostril (10 mg) Nasal powder: fully press and release button, insert into nostril with tight seal, rotate mouthpiece to place in mouth, blow forcefully to deliver powder, dis- card nosepiece repeat
Source page 1242
Extracted information for SUMAtriptan only.
Assess: • Migraine: type of pain, aura; alleviating, aggravating factors; sensitivity to light, noise • Increase: serotonin syndrome: de- lirium, coma, agitation, diaphoresis, hy- pertension, fever, tremors; may resemble neuroleptic malignant syndrome in pa- tients taking SSRIs, SNRIs • B/P; signs, symptoms of coronary va- sospasms, ECG • Tingling, hot sensation, burning, feel- ing of pressure, numbness, flushing, inj- site reaction • Stress level, activity, recreation, coping mechanisms • Neurologic status: LOC, blurring vision, nausea, vomiting, tingling in extremities preceding headache • Ingestion of tyramine foods (pickled products, beer, wine, aged cheese), food additives, preservatives, colorings, artifi- cial sweeteners, chocolate, caffeine, which may precipitate these types of headaches • Renal function, urinary output • Quiet, calm environment with de- creased stimuli: noise, bright light, ex- cessive talking • Pregnancy/breastfeeding: use only if benefits outweigh fetal risk; avoid breast- feeding
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Evaluate: • Therapeutic response: decrease in fre- quency, severity of migraine
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To report chest pain, tightness; sudden, severe abdominal pain; swelling of eyelids, face, lips; skin rash to prescriber immediately • To notify prescriber if pregnancy is planned or suspected; to use contracep- tion while taking product • Risk of medication overuse: do not use for abortive headache treatments more than 10 days/mo (ergotamines, trip- tans, opioids, or combinations) • Nasal spray: to use 1 spray in 1 nostril; may repeat if headache returns; not to repeat if pain continues after 1st dose • To have a dark, quiet environment • To avoid hazardous activities if dizzi- ness, drowsiness occur • To avoid alcohol; may increase headache • To use SUBCUT inj technique, nasal route if prescribed • That product does not reduce number of migraines; to be used for acute mi- graine; to use as symptoms occur • Nasal powder: Use in each nostril us- ing nosepiece and mouthpiece • SUBCUT: provide pamphlet from man- ufacturer, review with patient
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Extracted information for SUMAtriptan only.
PHARMACOKINETICS Onset of pain relief 10 min-2 hr, peak 2-4 hr, duration 24 hr; nasal onset 60 min, peak 2 hr; 10%-20% protein binding; metabolized in liver (metabolite); excreted in urine, feces; nasal spray half-life 2 hr
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Filter the extracted dose blocks for this individual drug.
• Adult: SUBCUT ≤6 mg; may repeat in 1 hr; max 12 mg/24 hr; PO 25 mg with fluids, if no relief in 2 hr, give another dose, max 200 mg/day; NASAL single dose of 5, 10, or 20 mg in 1 nostril, may repeat in 2 hr, max 40 mg/24 hr; 1 puff each nostril q2hr; nasal powder 11 mg in each nostril may repeat after 2 hr Hepatic dose
Candidate age grouping · source page 1242
• Adult: PO 25 mg; if no response after 2 hr, give ≤50 mg
Candidate age grouping · source page 1242