Sumatriptan
Indications for use
- Acute relief of migraine attacks, with or without aura
- SmPC states it should only be used where there is a clear diagnosis of migraine
Age
- 18-65 years
Dose/Directions
- One 50 mg tablet swallowed whole with water
- If symptoms respond to first tablet, but recur, a 2nd tablet can be taken, at least 2 hrs after first tablet. If no response to first tablet, 2nd tablet should not be taken for attack
- No more than 2 tablets in 24 hours or for same attack
Duration
- Refer if four or more attacks per month or if attacks are becoming more frequent, persistent or severe
Contra-indications/referral criteria
- Hypersensitivity to product or sulphonamides
- Previous MI, ischaemic heart disease, PVD, arrhythmias, coronary vasospasm
- History of stroke or TIA
- Moderate or severe hypertension, or mild uncontrolled hypertension
- Hepatic/renal impairment
- History of seizures or low seizure threshold
Examples of drug interactions
- Ergotamine
- MAOIs (need 2-week gap from finishing MAOI)
- Any triptan
- SSRIs/SNRIs: risk of serotonin syndrome; use with caution and observe the patient for signs of serotonin syndrome
Side-effects
- Dizziness, drowsiness, sensory disturbance including paraesthesia and hypoaesthesia, dyspnoea, nausea and vomiting, pain, sensations of heat or cold, pressure or tightness, sensations of heaviness
Other pertinent information
- Some guidance suggests the patient should have an established pattern of migraine (a history of five or more migraine attacks occurring over a period of at least 1 year) but this is not mentioned in all SmPCs for OTC sumatriptan
- Migraineurs who experience four or more migraine attacks per month should be referred to a doctor for ongoing management. It also states that patients who experience a change in the pattern of symptoms or with attacks becoming more frequent, more persistent, or more severe, or who do not recover completely between attacks, should seek advice from their doctor
- Migraineurs may be at risk of certain cerebrovascular events (such as cerebrovascular accident, transient ischaemic attack)
- Reclassified POM→P: 2006
- Imigran Recovery (the original OTC brand) has been discontinued; OTC sumatriptan 50 mg tablets are now available as own-brand and generic products (e.g. Boots Migraine Relief, MigraKind)