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Sumatriptan
💡 If a patient does not respond to one 5HT1-receptor agonist, an alternative 5HT1-receptor agonist should be tried. Always check the BNF here.
🔬 Mode of Action
- 5HT1-receptor agonists (triptans) cause selective vasoconstriction of cranial blood vessels and inhibit trigeminal nerve activation, relieving migraine headache and associated symptoms.
💊 Indications & Doses
- Acute migraine and cluster headache:
- Oral: Sumatriptan 50–100 mg; may repeat after ≥2 hrs if headache recurs; max 300 mg/24h.
- Subcutaneous (SC): Sumatriptan 6 mg stat; may repeat after ≥1 hr; max 12 mg/24h.
- Intranasal: 11–20 mg; max 40 mg/24h.
- ⚠️ Not indicated for hemiplegic, basilar, or ophthalmoplegic migraine.
⚖️ Interactions
- See BNF for full list (notably with SSRIs, MAOIs, and other triptans).
⚠️ Cautions
- Refer to BNF for details, but use carefully in patients with cardiovascular risk factors or poorly controlled hypertension.
🚫 Contraindications
- Ischaemic heart disease or previous MI.
- Coronary vasospasm (e.g. Prinzmetal’s angina).
- Uncontrolled or severe hypertension.
🤕 Side Effects
- Tingling, flushing, sensations of heat or heaviness.
- Chest or throat pressure (non-cardiac but alarming to patients).
- Dizziness, fatigue, nausea, vomiting.
- Rare: anaphylaxis.
💡 Teaching Pearls
- 🧠 Triptans should be taken at headache onset, not during aura phase (ineffective if taken too early).
- 🚑 Always exclude cardiovascular contraindications before prescribing - triptans can provoke coronary vasospasm.
- ⏱️ Rapid SC onset (<15 min) makes it useful in cluster headache, where speed of relief is crucial.
- 🔄 Non-response to one triptan doesn’t rule out benefit from another; switching is reasonable.
📚 References
| The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms. |
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