Sumatriptan parenteral
- Drugs List
- Therapeutic Indications
- Dosage
- Administration
- Contraindications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
- Monograph
Presentation
Parenteral formulation of sumatriptan.
Drugs List
Therapeutic Indications
Uses
Acute treatment of cluster headache
Acute treatment of migraine attacks with or without aura
Dosage
If the patient responds to the first dose and symptoms recur, a second dose may be administered if there is a minimum of one hour between the doses.
Maximum dose 12mg in any 24 hour period.
Adults
6mg by subcutaneous injection.
Some patients may benefit from a lower dose of 3mg by subcutaneous injection.
Children
Children aged 10 to 18 years (unlicensed):
6mg by subcutaneous injection.
Administration
Subcutaneous injection only.
Contraindications
Children under 10 years
Suspected ischaemic heart disease
Within 2 weeks of discontinuing MAOIs
Coronary vasospasm
History of cerebrovascular accident
History of myocardial infarction
History of transient ischaemic attack
Ischaemic heart disease
Moderate hypertension
Peripheral vascular disease
Prinzmetal's angina
Severe hepatic impairment
Uncontrolled hypertension
Precautions and Warnings
Children aged 10 to 18 years
Patients over 65 years
Predisposition to ischaemic heart disease
Tobacco smoking
Breastfeeding
Hepatic impairment
History of seizures
Hypertension
Pregnancy
Reduced seizure threshold
Renal impairment
Not for prophylactic use
Advise patient drowsiness may affect ability to drive or operate machinery
Avoid within 2 weeks of discontinuing a MAOI
Children under 18: Treatment to be initiated/supervised by a specialist
Evaluate patients for cardiovascular disease prior to treatment
Exclude other potentially serious neurological conditions
Not all available brands are licensed for all age groups
Not all available brands are licensed for all indications
Presentation (e.g. syringe, needle cap) may contain a derivative of latex
Avoid ergotamine-type medication for 6 hrs after sumatriptan administration
Avoid sumatriptan for 24hrs after ergotamine-type medication administration
For subcutaneous use only
Only for use where a clear diagnosis of migraine has been established
Only for use where there is a clear diagnosis of cluster headaches
When used with SSRIs, risk of Serotonin syndrome
Excessive use may increase frequency of headache, may require withdrawal
If angina-like symptoms occur, discontinue treatment and investigate.
Advise patient not to take St John's wort concurrently
Breastfeeding: Do not breastfeed & discard milk for 12 hours after therapy
Patients should not exceed recommended dose
Sumatriptan should not be administered to patients with risk factors for ischaemic heart disease for example in patients that are heavy tobacco smokers or use nicotine substitution therapies, without completing a cardiovascular examination prior to sumatriptan treatment. Sumatriptan should also be used with caution in postmenopausal women, and males over 40 years old with risk factors for ischaemic heart disease.
Sumatriptan should be used with caution in patients with mild controlled hypertension, as transient increases in blood pressure and peripheral vascular resistance has been shown in patients during use of sumatriptan.
Patient taking concomitant treatment with sumatriptan and a selective serotonin reuptake inhibitor (SSRI) should be under careful observation due to potential risk of developing serotonin.
Pregnancy and Lactation
Pregnancy
Use sumatriptan with caution during pregnancy.
The manufacturer recommends that sumatriptan should only be used if the potential benefit to the mother is greater than the potential risk to the foetus.
Schaefer (2015) states studies on the use of sumatriptan during pregnancy have not shown any increased risks of foetal teratogenic effects in humans. Briggs (2015) states that some animal studies have shown congenital defects, particularly rabbits, when administrated sumatriptan during pregnancy. There is limited published information regarding the use of sumatriptan crossing the placenta, however the molecular weight of approximately 414 suggests it is likely (Briggs, 2015). Fortunately, Briggs (2015) also states the risk of developing teratogenic effects in humans is considered low.
Lactation
Use sumatriptan with caution during breastfeeding.
The manufacturer recommends to avoid breastfeeding for 12 hours after treatment, due to sumatriptan excretion into breast milk.
Studies have shown sumatriptan to be excreted in breast milk when administrated by subcutaneous injection. Schaefer (2015) states the infants exposure to sumatriptan via breast milk after 6mg subcutaneous administration is most likely minimal as studies have shown the mean relative dose was found to be only 3.5% of the maternal dose, therefore if conventional treatment fails, a single dose of sumatriptan is considered relatively safe during breastfeeding. Briggs (2015) states any breast milk expressed for a minimum of 8 hours after treatment should be discarded. The manufacturer suggests to avoid breastfeeding for a minimum of 12 hours after treatment and any breast milk expressed in between that time should be discarded.
Side Effects
Altered liver function tests
Anaphylaxis
Angina
Anxiety
Arrhythmias
Arthralgia
Bradycardia
Bruising at injection site
Burning (injection site)
Coronary vasospasm
Diarrhoea
Diplopia
Dizziness
Drowsiness
Dysphagia
Dyspnoea
Dystonia
Erythema at injection site
Eye flickering
Fatigue
Flushing
Hyperhidrosis
Hypersensitivity reactions
Hypoaesthesia
Hypotension
Impaired vision
Increased blood pressure (transient)
Ischaemic colitis
Local pain (injection site)
Loss of vision
Minor bleeding (injection site)
Myalgia
Myocardial infarction
Nausea
Neck stiffness
Nystagmus
Pain
Palpitations
Paraesthesia
Raynaud's phenomenon
Scotoma
Seizures
Sensation of cold
Sensation of heat
Sensation of heaviness
Sensation of pressure
Sensation of tightness
Stinging (injection site)
Swelling (injection site)
Tachycardia
Transient ischaemic ECG changes
Tremor
Urticaria
Vomiting
Weakness
Overdosage
It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.
The following number will direct the caller to the relevant local centre (0844) 892 0111
Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Further Information
Last Full Review Date: December 2020
Reference Sources
Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 3rd edition (2015) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.
Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. Wolters Kluwer Health, Philadelphia.
Summary of Product Characteristics: Imigran Injection, Subject. GlaxoSmithKline UK. Revised September 2020.
Summary of Product Characteristics: Sumatriptan 3 mg/0.5 ml Solution for Injection in pre-filled pen. Ranbaxy UK Limited. Revised September 2020.
Summary of Product Characteristics: Sumatriptan 6 mg/0.5 ml Solution for Injection. Ranbaxy UK Limited. Revised September 2020.
NICE Evidence Services Available at: www.nice.org.uk Last accessed: 14 December 2020
Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content
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