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PubMed1994

The clinical profile of sumatriptan: efficacy in migraine.

The efficacy of the 5-HT1 receptor agonist sumatriptan in the acute treatment of migraine has been investigated in an extensive programme of controlled clinical trials. Sumatriptan provided rapid relief from migraine headache with onset of relief occurring within 10 min of a 6 mg subcutaneous injection and within 30 min of a 100 mg oral dose. Maximum benefit was observed by 2 h after the injection and 4 h after the oral dose. Sumatriptan also significantly decreased the incidence of associated migraine symptoms (nausea, photophobia, phonophobia) and the need for rescue medication. Sumatriptan was an effective treatment for migraine with and without aura and when used at any time during the attack. Oral sumatriptan 100 mg provided significantly greater pain relief and had a more rapid onset of action than two commonly used acute treatments for migraine. Efficacy is maintained in long-term use, with no evidence of tachyphylaxis or dependence. Sumatriptan, whether given subcutaneously or orally, is an effective long-term acute treatment for migraine.

Administration, Oral↗
PubMed1995

Sumatriptan in the treatment of cyclic vomiting.

OBJECTIVE: To describe a patient with cyclic vomiting who was treated successfully with sumatriptan, a serotonin, agonist. CASE SUMMARY: A patient with a 4-year history of cyclic vomiting was treated for an episode of nausea, vomiting, and abdominal pain. This patient had been hospitalized numerous times for cyclic vomiting over the previous 4 years, each hospitalization lasting from 3 to 11 days. Following a single subcutaneous injection of sumatriptan 6 mg, the patient ceased vomiting and was discharged 40 hours from the time of admission. DISCUSSION: The efficacy of sumatriptan in migraine headache appears to be mediated through its agonist activity at the serotonin1D receptor, resulting in constriction of dural blood vessels. According to published reports, therapeutic attempts at controlling cyclic vomiting often have included antimigraine therapies. Consistent with these reports, sumatriptan also appears effective in the treatment of cyclic vomiting. CONCLUSION: The pathogenesis of cyclic vomiting appears to share similarities with classic migraine, both of which may respond to sumatriptan therapy according to this report and previous work. Further study of the use of sumatriptan in the treatment of cyclic vomiting appears warranted.

Abdominal Pain↗
PubMed1992

Antimigraine drug sumatriptan increases blood flow velocity in large cerebral arteries during migraine attacks.

Sumatriptan, a novel selective 5-hydroxytryptamine1d (5-HT1d) receptor agonist, which is highly effective in the acute treatment of migraine attacks, blocks dural neurogenic plasma extravasation and constricts cranial blood vessels in animal experiments. We measured intra- and extracranial blood flow velocities (BFV) with a transcranial Doppler device in 67 patients during a spontaneous migraine attack, before and after treatment with 3 mg or 6 mg subcutaneous sumatriptan or placebo. Sumatriptan, but not placebo, significantly increased BFV (cm/sec) in the internal carotid and middle cerebral arteries on both sides, without detectably changing the BFV in the common and external carotid arteries. The rise in BFV increased with the dose of sumatriptan, parallel to an increase in proportion of patients improved. There were no significant changes in heart rate, blood pressure, or respiratory frequency after treatment with sumatriptan. The increase in BFV probably reflects vasoconstriction of the large basal intracranial arteries, which may be a mechanism for the antimigraine action of sumatriptan.

Adolescent↗
PubMed1996

A comparison of subcutaneous sumatriptan and dihydroergotamine nasal spray in the acute treatment of migraine.

We compared the efficacy and safety of subcutaneous (SC) sumatriptan (6 mg) with that of dihydroergotamine (DHE) nasal spray (1 mg plus optional 1 mg) in the acute treatment of migraine. Two hundred sixty-six adult migraineurs (International Headache Society criteria) completed a multicenter, double-blind, double-dummy, cross-over study. Patients took SC sumatriptan for one attack and DHE nasal spray for the other in random order. Data from both treatment periods show that at all time points from 15 minutes, SC sumatriptan was significantly better than DHE nasal spray at providing both headache relief (moderate/severe headache improving to mild/none) and resolution of headache. Similarly, SC sumatriptan was superior to DHE nasal spray for the other efficacy end points assessed in the study. Patients reported that both treatments were well tolerated. Adverse events were reported by 43% of patients taking SC sumatriptan and 22% of patients taking DHE nasal spray. These were usually mild and transient. We conclude that subcutaneous sumatriptan has a faster onset of action than DHE nasal spray and provides greater relief of acute migraine symptoms.

Administration, Intranasal↗
PubMed2006

Sumatriptan: update and review.

Sumatriptan is the first of a novel class of medications referred to as triptans. Since its approval for migraine in the 1990s, six other triptan products have received FDA approval. Despite the proliferation of triptans, sumatriptan remains the most frequently prescribed product in this therapeutic class. Sumatriptan has been instrumental in defining a biological basis for migraine. It is effective in treating migraine with or without aura, well tolerated and, when properly prescribed, safe. Sumatriptan injection is the only member of the triptan class approved for treatment of cluster headache. Studies with sumatriptan have also advanced the therapeutic intervention paradigm that permits patients to treat earlier and avoid substantial disability. Numerous pharmacoeconomic studies have demonstrated that sumatriptan decreases work loss productivity and improves quality of life.

Animals↗
PubMed1997

A multinational investigation of the impact of subcutaneous sumatriptan. II: Health-related quality of life.

The aim of this prospective sequential multinational (5 countries) study was to concurrently evaluate the effects of subcutaneous sumatriptan on clinical parameters, health-related quality-of-life (HRQOL) measures, workplace productivity and patient satisfaction. This report presents the HRQOL results. 582 patients (aged 18 to 65 years) with moderate to severe migraine received their customary antimigraine therapy for 12 weeks and then subcutaneous sumatriptan for 24 weeks. The Short Form-36 Health Survey and the Migraine-Specific Quality of Life Questionnaire were completed at a screening visit (base-line), at the end of the 12-week customary therapy phase, and at 12 and 24 weeks of the sumatriptan phase. Scores for most of the Short Form-36 dimensions improved significantly (p < 0.05) after 12 and 24 weeks of sumatriptan therapy compared with 12 weeks of customary therapy, in each country. Similarly, scores on all Migraine-Specific Quality of Life Questionnaire dimensions were significantly (p < 0.05; paired t-test) improved after 12 weeks (in all countries) and 24 weeks (in 4 of 5 countries) of sumatriptan therapy compared with 12 weeks of customary therapy. This study demonstrates that, in 5 countries, treatment of migraine attacks with subcutaneous sumatriptan compared with customary therapy was associated with improvements in HRQOL, as measured by both general health status and disease-specific instruments.

Adolescent↗
PubMed1997

A multinational investigation of the impact of subcutaneous sumatriptan. III: Workplace productivity and non-workplace activity.

This report presents the workplace productivity and non-workplace activity results of a multinational study of the effects of subcutaneous sumatriptan 6 mg in the acute treatment of migraine compared with patient's customary therapy. Patients diagnosed with migraine treated their symptoms for 24 weeks with subcutaneous sumatriptan after a 12-week period of treating symptoms with their customary (non-sumatriptan) therapy. Patients used diary cards to record information concerning the effects of migraine on workplace productivity and non-workplace activity time. The average workplace productivity time lost was 23.4 hours per patient during 12 weeks of customary therapy, compared with 7.2 and 5.8 hours per patient during the first and second 12-week periods of sumatriptan therapy, respectively. An average of 9.3 hours of non-workplace activity time was lost per patient during the customary therapy phase, compared with 3.2 and 2.8 hours during the first and second 12-week periods of sumatriptan therapy, respectively. Treatment of migraine with subcutaneous sumatriptan compared with customary therapy was associated with an average gain per patient of approximately 16 hours of workplace productivity time and 6 hours of non-workplace activity time, over a 3-month period.

Adolescent↗
PubMed2005

Intranasal sumatriptan: in adolescents with migraine.

Sumatriptan, a serotonin 5-HT(1B/1D) agonist, constricts cranial blood vessels and inhibits neuroinflammatory processes. A single dose of sumatriptan 10 mg (approved European dosage) was significantly more effective than placebo in achieving headache relief at 1 hour post-dose in a well designed study. Headache relief occurred in significantly more adolescents administered a single dose of intranasal sumatriptan 20 mg (at 1 and 2 hours) and 5 mg (at 2 hours) than placebo (pooled data from two studies). Sustained headache relief (1-24 and 2-24 hours) occurred in significantly more recipients of a single dose of intranasal sumatriptan 20mg and 5mg than placebo (pooled data from two studies). Intranasal sumatriptan was generally well tolerated in adolescent migraineurs (in single-episode studies or long term in multiple-episode studies). Taste disturbance occurred more often with intranasal sumatriptan than with placebo [Chart: see text].

Administration, Intranasal↗
PubMed1998

Effect of subcutaneous sumatriptan on head temperature in migraines.

Sumatriptan, a selective 5-hydroxy-triptamine (5-HT1) receptor agonist, has been used recently in the treatment of acute migraine. Some in vitro experiments suggested that sumatriptan has vasoactive properties in vascular beds distinct from cerebral circulation. In view of this we investigated the vascular effects of the standard 6 mg subcutaneous (s.c.) dose of sumatriptan, on the surface areas of the head using thermography, a simple and reliable method for detecting temperature changes. The head temperature of 127 patients (double-blind), 102 migraines (52 during headache attack and 50 headache-free) and 25 healthy control subjects were evaluated using thermography in basal condition and 30, 60, 90, and 120 min after s.c. sumatriptan injection of placebo. During the entire observation period systemic blood pressure (SBP), heart rate (HR) and continuous electrocardiogram (ECG) were detected automatically. A significant head temperature decrease was observed after s.c. sumatriptan administration, in both healthy controls and migraine subjects; placebo administration did not show any change of temperature. In migraine patients during headache attack, head temperature reduction corresponded to the relief of headache symptoms. This vasoconstrictor effect detected with thermography is not isolated to cranial circulation but it is also systemic. In fact, we observed a significant increase (p < 0.05) in both systolic and diastolic systemic blood pressure. No significant changes in heart rate and ECG abnormalities were otherwise detected. These findings suggest that sumatriptan is effective in the treatment of migraine attack, but it must be used with caution in migraines with concomitant hypertension.

Adult↗
PubMed2000

[Sumatriptan nasal spray 20mg: efficacy, tolerance and quality of life in migraine patients].

UNLABELLED: The primary objective of this prospective, open, non controlled, multicenter study was to collect data on migraine patients' health related quality of life before and after treatment of their migraine attacks by sumatriptan nasal spray 20 mg over a 12 week period. The impact on health related quality of life was evaluated by the mean change from pre-treatment scores french migraine health related quality of life specific questionnaire (QVM). A total of 219 patients have been included in the study, whose migraine attacks were not usually relieved by first line therapy. A statistically significant improvement in health related quality of life (as measured by the global score and the four scores related to the four dimensions of the QVM questionnaire (functional, psychological, social and therapeutic) were observed compared to the pre-treatment score values. At the end of the treatment period, 60% of patients preferred sumatriptan nasal spray 20 mg to their usual treatment. Headache relief was reported 2 hours after administration in 66% of attacks treated by sumatriptan nasal spray 20 mg during the study period and pain free in 46% of treated attacks. The nature and incidence of adverse events were similar to these observed in previous studies performed with sumatriptan nasal spray 20 mg and no unexpected events were reported. CONCLUSION: Those data suggest for the first time that the use of sumatriptan nasal spray 20 mg for the treatment of migraine attacks during a 12 week period may be associated with a significant improvement in migraine patients' quality of life. The clinical efficacy and tolerability results observed in this study are similar to those from controlled studies previously published with sumatriptan nasal spray 20 mg.

Administration, Intranasal↗
PubMed2002

Sumatriptan nasal spray for migraine: a review of studies in patients aged 17 years and younger.

This review considers the epidemiology, clinical manifestations and functional consequences of migraine in children and adolescents and surveys the studies establishing the efficacy and tolerability of sumatriptan nasal spray in this patient population. Although therapeutic advances in paediatric and adolescent migraine have lagged behind those in adult migraine, the first systematic studies of migraine medications in young patients have brought about progress in the past five years. These studies show that therapeutic approaches suitable for adult patients are not always applicable to paediatric and adolescent patients. Because of the unique characteristics of paediatric and adolescent migraine, it has been difficult to demonstrate in young patients the efficacy of oral sumatriptan and other triptan tablets, which are the medications of choice for adult migraine. With sumatriptan, this finding has proven to be a consequence of the form in which the drug was administered rather than the inherent properties of the drug. The availability of sumatriptan nasal spray allows the benefits of migraine-specific therapy to be extended to children and adolescents. In both well-controlled, single-episode studies and long-term, multiple-episode studies, sumatriptan nasal spray has been effective and well tolerated for the acute treatment of migraine in children and adolescents. Except for unpleasant taste, which is not significantly distressing to patients, sumatriptan nasal spray has a tolerability profile similar to thatof placebo in young patients.

Administration, Intranasal↗
PubMed2003

Patients with migraine prefer zolmitriptan orally disintegrating tablet to sumatriptan conventional oral tablet.

The Zolmitriptan Evaluation versus Sumatriptan Trial (ZEST) assessed patient preference for 2.5 mg zolmitriptan orally disintegrating tablet (ODT) or 50 mg sumatriptan conventional tablet in 218 patients with significant migraine disability. Significantly more patients preferred zolmitriptan ODT to sumatriptan conventional tablet (60.1% vs 39.9%; p = 0.0130). In terms of efficacy, significantly more patients considered zolmitriptan ODT to be an effective migraine treatment than sumatriptan conventional tablet (77% vs 63%; p = 0.0063). When asked about specific formulation attributes, significantly more patients selected zolmitriptan ODT as the least disruptive therapy (83.6% vs 16.4%), the easiest to take (85.5% vs 14.5%), the most convenient to take (86.1% vs 13.9%), and the one which enabled them to maintain an active lifestyle (65.5% vs 34.5%), compared with the sumatriptan conventional tablet (all comparisons p < 0.001). Zolmitriptan ODT is a convenient and beneficial alternative to conventional tablets and is preferred to sumatriptan conventional tablets by migraineurs.

Administration, Oral↗
PubMed2005

Nasal sumatriptan: new dosage. For adolescents with migraine: too little benefit.

(1) The reference first-line drug therapy for migraine attacks in adolescents is a non specific analgesic such as paracetamol or a nonsteroidal antiinflammatory drug like ibuprofen. Two specific analgesics are authorised for use in this setting in France, namely ergotamine and dihydroergotamine. (2) Nasal sumatriptan is the first triptan to be licensed for this age group in France. (3) Evaluation data includes three flawed placebo-controlled trials. (4) Effects were modest at best. Only one of the three trials showed that sumatriptan was more likely than placebo to give complete pain relief within two hours. The three trials fail to show that sumatriptan is effective against symptoms such as nausea and vomiting, photophobia and phonophobia. (5) The principal known adverse effects of sumatriptan are chest tightness, flushing, and increased blood pressure. (6) In the only trial report containing relevant information, unpleasant taste was the only adverse effect more commonly associated with sumatriptan than with placebo. (7) Postmarketing follow-up revealed a number of serious adverse effects, including stroke, myocardial infarction and loss of vision. (8) The packs containing 6 or 12 spray vials carry a risk of overuse and self-induced headache. (9) In practice, sumatriptan must not be used to treat migraine attacks in adolescents.

Administration, Intranasal↗
PubMed1995

Cerebral blood flow effects of sumatriptan in drug combinations in the baboon model.

Sumatriptan (CAS 103628-46-2, Imigran) has established itself as an important therapeutic agent in the treatment of migraine. Although considerable understanding of, in particular, the vascular pathophysiology of migraine has been gained during the past decade, the pathophysiology and mediators involved in the pain experience during migraine ar during migraine are not yet fully explained. The mechanisms behind the pharmacological effects of sumatriptan are still only partially understood. In the present study the effects of sumatriptan on drug induced cerebral blood flow increases in the baboon model were investigated using 99mTc-HMPAO (hexamethylpropylene amine oxime) and SPECT (single photon emission computed tomography). Sumatriptan selectively reduced drug induced cerebral blood flow increases. The effects of halothane anaesthesia and acetazolamide on cerebral blood flow were not reversed by sumatriptan, while the effect of nimodipine was attenuated by 47% (to the level of cerebral blood flow below the normal flow baseline). These results support multiple mechanisms for sumatriptan involving vascular neurotransmission and neurogenic inflammatory responses via serotonin receptor stimulation and Ca2+ mobilization. Drug-drug interactions are further implicated through this study.

Acetazolamide↗
PubMed1995

Oral sumatriptan for the long-term treatment of migraine: clinical findings.

This double-blind, placebo-controlled, crossover study of the acute treatment of migraine investigated the efficacy and tolerability of oral sumatriptan 100 mg (Imitrex) administered for up to nine attacks compared with placebo administered for up to three attacks. Patients were randomized to receive oral sumatriptan 100 mg or placebo on an outpatient basis in a 3:1 ratio for three four-attack blocks. Headache relief 4 hours postdose was observed in 59 to 65% of patients after sumatriptan treatment compared with 18 to 23% of patients after placebo treatment across three four-attack blocks (p < 0.005). For each block, oral sumatriptan 100 mg was also significantly more effective than placebo at relieving clinical disability and nausea and vomiting. Efficacy on all these measures was consistently maintained with repeated administration. Oral sumatriptan 100 mg was well tolerated, and repeated administration did not alter the pattern or severity of adverse events. These data demonstrate that the efficacy and tolerability of oral sumatriptan 100 mg was consistently maintained with repeated administration for up to nine separate migraine attacks.

Administration, Oral↗
PubMedDate not supplied

[Clinical experience with sumatriptan ++ in the treatment of migraine symptoms].

Although sumatriptan has proven effective in treating migraine symptoms, there have been no studies comparing this drug with non-steroid anti-inflammatory drugs (NSAIDs) and ergotamine compounds under ideal dosage and delivery conditions. Our study aimed to establish the objective and subjective effects of treatment of severe migraine attacks with subcutaneous sumatriptan in a series of patients who were resistant to or intolerant of NSAIDs or ergotamine derivatives. Twenty-three patients were treated for a total of 140 attacks of migraine (mean +/- SD = 6 +/- 4 attacks). In 26% of the patients and in 23% of the attacks the response to sumatriptan was inadequate, while the response was clearly positive in 74% of the patients and in 77% of the attacks. More than half the patients responded within the first 30 min after injection of the drug. In 52% side effects were reported, although none were severe. Side effects continued with the same intensity or decreased in 91% of the patients in the course of the study. No patient considered treatment with sumatriptan worse than treatment with ergotamines or NSAIDs, while 86% and 91% labelled sumatriptan as "better" or "much better" than NSAIDs and ergotamines, respectively. Eighteen (78%) stated that they would continue using sumatriptan for future migraine attacks. Finally, most considered price to be a factor to be taken into consideration in deciding whether to inject the drug indiscriminately.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Treatment of menstruation-associated migraine headache with subcutaneous sumatriptan.

OBJECTIVE: To evaluate the efficacy and safety of sumatriptan, a 5-HT1 receptor agonist, in patients with menstruation-associated migraine. METHODS: Two double-blind, placebo-controlled, single-attack parallel group studies of subcutaneous sumatriptan were conducted for the acute treatment of migraine. A retrospective analysis of 1104 patients produced 157 women who were treated for a menstruation-associated migraine (defined as a migraine beginning between 1 day before and 4 days after the onset of menstrual flow) and 512 women treated for nonmenstrual migraine. We excluded 435 other patients who were either male (123), women with hysterectomies (260), or women with missing data (52). Patients with moderate or severe pain were treated with 6 mg subcutaneous sumatriptan or placebo. One hour after treatment, response rates of headache severity and associated symptoms were measured. Menstruation-associated migraine patients were compared to female patients with nonmenstrual migraine. Migraine recurrence was analyzed retrospectively for 24 hours. RESULTS: At 1 hour, 80% of the sumatriptan-treated menstrual-migraine patients had pain relief (reduction of severe or moderate pain to mild or no pain), compared to 19% of the placebo patients (P < .001). Sumatriptan also treated nausea and photophobia more effectively in menstrual-migraine patients than did placebo. Response rates for pain and associated symptoms were similar between patients with menstruation-associated and nonmenstrual migraines. Adverse effects were also similar between the groups. CONCLUSION: Sumatriptan was as effective and well tolerated for menstruation-associated migraine as it was for nonmenstrual migraine.

Adolescent↗
PubMed1996

Subcutaneous sumatriptan for the treatment of migraine: humanistic, economic, and clinical consequences.

OBJECTIVES: This study examined the humanistic, economic, and clinical consequences of using subcutaneous sumatriptan for 6 months for the acute treatment of migraine in 126 patients enrolled in a group-model health maintenance organization. METHODS: Patients received open-label sumatriptan (6 mg) for the treatment of migraines that occurred during a 6-month period. For each migraine, patients recorded migraine pain severity (none, mild, moderate, or severe) before treatment and 2 hours posttreatment and the time until onset of patient-defined meaningful relief. Patients also completed both the Short Form-36 Health Survey and Migraine-specific Quality of Life (QOL) Questionnaire at screening (to cover the period prior to initiation of treatment) and after 3 and 6 months of treatment. Patients' medical records were reviewed to obtain information on the frequency of migraine-related pharmacy use, general outpatient services, and urgent care services during the treatment period and the 12 months prior to initiation of treatment. RESULTS: By 2 hours after the dose, 71% of patients had moderate or severe pain reduced to mild or none, and 86% of patients achieved meaningful relief. At 3 months and 6 months, sumatriptan was associated with improvements relative to pre-sumatriptan baselines in Short Form-36 Health Survey and Migraine-specific QOL Questionnaire scores (P < .002). Sumatriptan was also associated with significant reductions in the average number of migraine-related general outpatient and urgent care services (P < .001). CONCLUSIONS: The use of sumatriptan for 6 months was associated with improvements in health-related quality of life, reductions in health care resource use, and a high percentage of treatment successes.

Adolescent↗