'''Sumatriptan''' is a synthetic drug belonging to the [[triptan]] class, used for the treatment of [[migraine]] headaches. Structurally, it is an analog of the naturally occurring neuro-active [[alkaloids]] [[dimethyltryptamine]] ([[O-Desmethyltramadol|DMT]]), [[bufotenine]], and [[5-methoxy-dimethyltryptamine]], with an N-methyl sulfonamidomethyl- group at position C-5 on the [[indole]] ring.<ref>The presence of the [[Sulfonamide (chemistry)|sulfonamide]] group in the molecule does not make sumatriptan a "sulfa drug", since it does not have any [[anti-microbial]] properties.</ref>
: [[File:{{PAGENAME}}01.png|thumb|none|600px|This image is provided by the National Library of Medicine.]]
==Category==
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Serotonin Receptor Agonists; Antimigraine Agents
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==FDA Package Insert==
There is limited information regarding <i>Pharmacodynamics</i> of {{PAGENAME}} in the drug label.
====IMITREX (sumatriptan succinate) injection====
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''' [[IMITREX injection indications and usage|Indications and Usage]]'''
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'''| [[IMITREX injection dosage and administration|Dosage and Administration]]'''
'''| [[IMITREX injection dosage forms and strengths|Dosage Forms and Strengths]]'''
'''| [[IMITREX spray labels and packages|Labels and Packages]]'''
==Adverse Effects==
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Large doses of sumatriptan can cause [[sulfhemoglobinemia]], a rare condition in which the blood changes from red to greenish-black, due to the integration of [[sulfur]] into the [[hemoglobin]] molecule.<ref>{{cite news|url=http://news.bbc.co.uk/2/hi/health/6733203.stm|title=Patient bleeds dark green blood|date=8 June 2007|work=BBC News|accessdate=6 March 2010}}</ref> If sumatriptan is discontinued, the condition reverses within a few weeks.
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Serious cardiac events, including some that have been fatal, have occurred following the use of sumatriptan injection or tablets. Events reported have included coronary artery vasospasm, transient myocardial ischemia, [[myocardial infarction]], [[ventricular tachycardia]], and ventricular fibrillation. {{Citation needed|date=December 2011}}
There is limited information regarding <i>Clinical Studies</i> of {{PAGENAME}} in the drug label.
The most common side-effects<ref>[http://www.fda.gov/ohrms/dockets/ac/05/briefing/2005-4180b_09_05_Imitrex%20label%20tablet%2012-04%20Sponsor.pdfsumatriptan Tablets]</ref> reported by at least 2% of patients in controlled trials of sumatriptan (25, 50, and 100 mg tablets) for migraine are atypical sensations (paresthesias and warm/cold sensations) reported by 4% in the placebo group and 5–6% in the sumatriptan groups, pain and other pressure sensations (including chest pain) reported by 4% in the placebo group and 6–8% in the sumatriptan groups, neurological events ([[vertigo]]) reported by less than 1% in the placebo group and less than 1% to 2% in the sumatriptan groups. Malaise/fatigue occurred in less than 1% of the placebo group and 2–3% of the sumatriptan groups. Sleep disturbance occurred in less than 1% in the placebo group to 2% in the sumatriptan group.
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==Mechanism of Action==
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Sumatriptan is structurally similar to [[serotonin|serotonin (5-HT)]], and is a selective [[agonist]] for [[5-HT1D|5-HT<sub>1D</sub>]] and [[5-HT1B|5-HT<sub>1B</sub>]] receptors which are present on the cranial vasculature.<ref>{{cite journal |author=Razzaque Z, Heald MA, Pickard JD, ''et al.'' |title=Vasoconstriction in human isolated middle meningeal arteries: determining the contribution of 5-HT1B- and 5-HT1F-receptor activation |journal=Br J Clin Pharmacol |volume=47 |issue=1 |pages=75–82 |year=1999 |pmid=10073743 |pmc=2014192|doi=10.1046/j.1365-2125.1999.00851.x}}</ref> By activating these receptors, sumatriptan causes [[vasoconstriction]] and reduces neurogenic [[inflammation]] associated with antidromic neuronal transmission correlating with relief of [[migraine]].
*
Sumatriptan is also shown to decrease the activity of the [[trigeminal nerve]], which, it is presumed, accounts for sumatriptan's efficacy in treating [[Cluster Headache|cluster headaches]]. The injectable form of the drug has been shown to abort a cluster headache within fifteen minutes in 96% of cases.<ref>[http://dx.doi.org/10.1056/NEJM199108013250505 Treatment of acute cluster headache with sumatriptan. The Sumatriptan Cluster Headache Study Group. N Engl J Med 1991;325:322-6.]</ref>
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==Pharmacokinetics==
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Sumatriptan is administered in several forms; tablets, [[subcutaneous injection]], and nasal spray. Oral administration (as [[succinate]]) suffers from poor [[bioavailability]], partly due to presystemic [[metabolism]]—some of it gets broken down in the stomach and bloodstream before it reaches the target arteries. A new rapid-release tablet formulation has the same bioavailability, but the maximum concentration is achieved on average 10–15 minutes earlier. When injected, sumatriptan is faster-acting (usually within 10 minutes), but the effect lasts for a shorter time. Sumatriptan is metabolised primarily by [[Monoamine oxidase|monoamine oxidase A]] into an [[indole acetic acid]] analogue, part of which is further conjugated with [[glucuronic acid]]. These metabolites are excreted in the urine and bile. Only about 3% of the active drug may be recovered unchanged.
There is limited information regarding <i>Patient Counseling Information</i> of {{PAGENAME}} in the drug label.
There is no simple, direct relationship between sumatriptan concentration (pharmacokinetics) per se in the blood and its anti-migraine effect (pharmacodynamics). This paradox has, to some extent, been resolved by comparing the rates of absorption of the various sumatriptan formulations, rather than the absolute amounts of drug that they deliver.<ref>{{cite pmid|14756852}}</ref><ref>{{cite pmid|15953294}}</ref>
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==Approval==
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Sumatriptan was the first clinically available [[triptan]] (in 1991). In the United States, it is available only by medical prescription. However, it can be bought over the counter in the UK and Sweden in 50 mg dosage. Several dosage forms for sumatriptan have been approved, including [[Tablet (pharmacy)|tablets]], solution for [[Injection (medicine)|injection]], and nasal [[inhaler]]s.
* Alcohol-{{PAGENAME}} interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.
On April 15, 2008, the US FDA approved [[Treximet]], a combination of sumatriptan and [[naproxen]], an [[NSAID]].<ref>[http://www.gsk.com/media/pressreleases/2008/2008_us_pressrelease_10034.htm GSK press release – Treximet (sumatriptan and naproxen sodium) tablets approved by FDA for acute treatment of migraine]</ref> This combination has shown a benefit over either medicine used separately.<ref name="pmid17405970">{{cite journal |author=Brandes JL, Kudrow D, Stark SR, ''et al.'' |title=Sumatriptan-naproxen for acute treatment of migraine: a randomized trial |journal=JAMA |volume=297 |issue=13 |pages=1443–54 |date=April 2007|pmid=17405970 |doi=10.1001/jama.297.13.1443 |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=17405970}}</ref>
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In July 2009, the US FDA approved a single-use [[jet injector]] formulation of sumatriptan. The device delivers a subcutaneous injection of 6 mg sumatriptan, without the use of a needle. [[Autoinjector]]s with needles have been previously available in Europe and North America for several years.<ref name=Brandes>{{cite pmid|19849720}}</ref>
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Phase III studies with a [[iontophoretic]] [[transdermal patch]] (Zelrix/Zecuity) started in July 2008.<ref>{{ClinicalTrialsGov|NCT00724815|The Efficacy and Tolerability of NP101 Patch in the Treatment of Acute Migraine (NP101-007)}}</ref> This patch uses low [[voltage]] controlled by a pre-programmed [[Integrated circuit|microchip]] to deliver a single dose of sumatriptan through the skin within 30 minutes.<ref>[http://www.nupathe.com/description.php?secid=3&subsecid=7#_ELECTRONIC_DRUG SmartRelief -electronically assisted drug delivery (iontophoresis)]</ref><ref>{{cite journal|pmid=19438727|year=2009|last1=Pierce|first1=M|last2=Marbury|first2=T|last3=O'Neill|first3=C|last4=Siegel|first4=S|last5=Du|first5=W|last6=Sebree|first6=T|title=Zelrix: a novel transdermal formulation of sumatriptan|volume=49|issue=6|pages=817–25|doi=10.1111/j.1526-4610.2009.01437.x|journal=Headache}}</ref> Zecuity was approved by the US FDA in January 2013.<ref>[http://ir.nupathe.com/press-releases/nupathe-s-zecuity-approved-by-the-fda-for-the-acut-nasdaq-path-975802NuPathe's Zecuity Approved by the FDA for the Acute Treatment of Migraine]</ref>
* ®<ref>{{Cite web | title = | url = }}</ref>
===Generics===
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On November 6, 2008, [[Par Pharmaceutical]] announced that it would begin shipping generic versions of sumatriptan injection (sumatriptan succinate injection) 4 mg and 6 mg starter kits and 4 mg and 6 mg pre-filled syringe cartridges to the trade immediately. In addition, Par anticipates launching the 6 mg vials early in 2009.<ref>{{cite news |title=PAR PHARMACEUTICAL BEGINS SHIPMENT OF SUMATRIPTAN INJECTION |url=http://www.parpharm.com/media/NR_20081106.jsp |work=Par Pharmaceutical |date= 2008-11-06|accessdate=2008-11-25 }} {{Dead link|date=October 2010|bot=H3llBot}}</ref>
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[[Mylan|Mylan Laboratories Inc.]], Ranbaxy, Sandoz, Dr. Reddy's Pharmaceuticals and other companies have received FDA approval for generic versions of Imitrex tablets in 25-, 50-, and 100-milligram doses since 2009. The drug is available in U.S. and European markets, since Glaxo's patent protections have expired in those jurisdictions. However, sales of a generic delivered via nasal spray are still restricted in the United States.
* A® — B®<ref name="www.ismp.org">{{Cite web | last = | first = | title = http://www.ismp.org | url = http://www.ismp.org | publisher = | date = }}</ref>
See also Sumavel DosePro (above).<ref name=Brandes/>
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==Chemistry==
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[[File:Sumatriptan synth.png|600px]]
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{{US patent|4,785,016}}
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==References==
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{{Reflist|2}}
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Black Box Warning
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See full prescribing information for complete Boxed Warning.
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Sumatriptan (oral) is a that is FDA approved for the {{{indicationType}}} of . There is a Black Box Warning for this drug as shown here. Common adverse reactions include .
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There is limited information regarding Off-Label Guideline-Supported Use of Sumatriptan (oral) in adult patients.
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There is limited information regarding Off-Label Non–Guideline-Supported Use of Sumatriptan (oral) in adult patients.
Pediatric Indications and Dosage
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There is limited information regarding FDA-Labeled Use of Sumatriptan (oral) in pediatric patients.
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There is limited information regarding Off-Label Non–Guideline-Supported Use of Sumatriptan (oral) in pediatric patients.
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There is limited information regarding Clinical Trial Experience of Sumatriptan (oral) in the drug label.
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Postmarketing Experience
There is limited information regarding Postmarketing Experience of Sumatriptan (oral) in the drug label.