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Pronunciation
(soo ma TRIP tan)
Generic Available (U.S.)
Yes
Index Terms
Brand Names: U.S.
Brand Names: Canada
Pharmacologic Category
Pharmacologic Category Synonyms
Use: Labeled Indications
Intranasal, Oral, SubQ: Acute treatment of migraine with or without aura
SubQ: Acute treatment of cluster headache episodes
Pregnancy Risk Factor
C
Pregnancy Considerations
There are no adequate and well-controlled studies using sumatriptan in pregnant women. Use only if potential benefit to the mother outweighs the potential risk to the fetus. A pregnancy registry has been established to monitor outcomes of women exposed to sumatriptan during pregnancy (800-336-2176). Preliminary data from the registry do not suggest a greater risk of birth defects than the general population and so far a specific pattern of malformations has not been identified. However, sample sizes are small and studies are ongoing. In some (but not all) animal studies, administration was associated with embryolethality, fetal malformations and pup mortality.
Lactation
Enters breast milk/use caution (AAP rates “compatible”; AAP 2001 update pending)
Breast-Feeding Considerations
The amount of sumatriptan an infant would be exposed to following breast-feeding is considered to be small (although the mean milk-to-plasma ratio is ~4.9, weight adjusted doses estimates suggest breast-fed infants receive 3.5% of a maternal dose). Expressing and discarding the milk for 8-12 hours after a single dose is suggested to reduce the amount present even further. The half-life of sumatriptan in breast milk is 2.22 hours.
Contraindications
Hypersensitivity to sumatriptan or any component of the formulation; patients with ischemic heart disease or signs or symptoms of ischemic heart disease (including Prinzmetal's angina, angina pectoris, myocardial infarction, silent myocardial ischemia); cerebrovascular syndromes (including strokes, transient ischemic attacks); peripheral vascular disease (including ischemic bowel disease); uncontrolled hypertension; use within 24 hours of ergotamine derivatives; use within 24 hours of another 5-HT1 agonist; concurrent administration or within 2 weeks of discontinuing an MAO type A inhibitors (oral and nasal sumatriptan only; see Warnings/Precautions); management of hemiplegic or basilar migraine; severe hepatic impairment (oral and nasal sumatriptan, and injectable Imitrex® only); not for I.V. administration
Warnings/Precautions
Concerns related to adverse effects:
• Cardiac events: Coronary artery vasospasm, transient ischemia, myocardial infarction, ventricular tachycardia/fibrillation, cardiac arrest, and death have been reported with 5-HT1 agonist administration. Patients who experience sensations of chest pain/pressure/tightness or symptoms suggestive of angina following dosing should be evaluated for coronary artery disease or Prinzmetal's angina before receiving additional doses; if dosing is resumed and similar symptoms recur, monitor with ECG.
• Cerebrovascular events: Cerebral/subarachnoid hemorrhage and stroke have been reported with 5-HT1 agonist administration.
• Elevated blood pressure: Significant elevation in blood pressure, including hypertensive crisis, has also been reported on rare occasions in patients with and without a history of hypertension. Use is contraindicated in patients with uncontrolled hypertension.
• Vasospasm-related events: Peripheral vascular ischemia and colonic ischemia have been reported with 5-HT1 agonists. Transient and permanent blindness and significant partial vision loss have been very rarely reported.
Disease-related concerns:
• Coronary artery disease: Should not be given to patients who have risk factors for CAD (eg, hypertension, hypercholesterolemia, smoker, obesity, diabetes, strong family history of CAD, menopause, male >40 years of age) without adequate cardiac evaluation. Patients with suspected CAD should have cardiovascular evaluation to rule out CAD before considering use; if cardiovascular evaluation is “satisfactory,” first dose should be given in the healthcare provider's office (consider ECG monitoring). Periodic evaluation of cardiovascular status should be done in all patients.
• Hepatic impairment: Use oral formulations of sumatriptan with caution (and with dosage limitations) in patients with hepatic impairment where treatment is necessary and advisable. Presystemic clearance of orally administered sumatriptan is reduced in hepatic impairment, leading to increased plasma concentrations; dosage reduction of the oral product is recommended. Non-oral routes of administration (nasal, subcutaneous formulations) do not undergo similar hepatic first-pass metabolism and are not expected to result in significantly altered pharmacokinetics in patients with hepatic impairment. Use of the oral, nasal, or Imitrex® injectable is contraindicated in severe hepatic impairment.
• Seizure disorders: Use with caution in patients with history of seizure disorder or in patients with a lowered seizure threshold.
Concurrent drug therapy issues:
• MAO inhibitors: Concurrent use with an MAO inhibitor may result in increased sumatriptan concentrations and increased risk for dose-related adverse effects (eg, serotonin syndrome); use with oral or nasal sumatriptan is contraindicated. Although generally not recommended, if concomitant use with injectable sumatriptan is deemed necessary, careful monitoring and appropriate dosage adjustments are required.
• Serotonin syndrome: Symptoms of agitation, confusion, hallucinations, hyper-reflexia, myoclonus, shivering, and tachycardia may occur with concomitant proserotonergic drugs (ie, SSRIs/SNRIs or triptans) or agents which reduce sumatriptan's metabolism. Concurrent use of serotonin precursors (eg, tryptophan) is not recommended. If concomitant administration with SSRIs is warranted, monitor closely, especially at initiation and with dose increases.
Special populations:
• Elderly: Not recommended for use in elderly patients; older adults are at a higher risk for coronary artery disease and may be more likely to have reduced hepatic function.
Other warnings/precautions:
• Appropriate administration: I.V. administration is contraindicated due to the potential to cause coronary vasospasm.
• Appropriate use: Only indicated for the acute treatment of migraine or cluster headache (depending on product); not indicated for migraine prophylaxis, or for the treatment of hemiplegic or basilar migraine. If a patient does not respond to the first dose, the diagnosis of migraine or cluster headache should be reconsidered; rule out underlying neurologic disease in patients with atypical headache and in patients with no prior history of migraine or cluster headache.
Adverse Reactions
Injection:
>10%:
Central nervous system: Dizziness (12%), warm/hot sensation (11%)
Local: Injection site reaction (≤86%; includes bleeding, bruising, edema, and erythema)
Neuromuscular & skeletal: Paresthesia (5% to 14%)
1% to 10%:
Cardiovascular: Chest discomfort/tightness/pressure (2% to 5%)
Central nervous system: Burning sensation (7%), feeling of heaviness (7%), flushing (7%), pressure sensation (7%), feeling of tightness (5%), drowsiness (3%), feeling strange (2%), headache (2%), tight feeling in head (2%), anxiety (1%), cold sensation (1%), malaise/fatigue (1%)
Gastrointestinal: Nausea/vomiting (4%), abdominal discomfort (1%), dysphagia (1%)
Neuromuscular & skeletal: Neck pain/stiffness (5%), numbness (5%), weakness (5%), jaw discomfort (2%), myalgia (2%), muscle cramps (1%)
Ocular: Vision alterations (1%)
Respiratory: Throat discomfort (3%), nasal disorder/discomfort (2%), bronchospasm (1%)
Miscellaneous: Diaphoresis (2%)
Nasal spray:
>10%: Gastrointestinal: Bad taste (13% to 24%), nausea (11% to 13%), vomiting (11% to 13%)
1% to 10%:
Central nervous system: Dizziness (1% to 2%)
Respiratory: Nasal disorder/discomfort (2% to 4%), throat discomfort (1% to 2%)
Tablet:
1% to 10%:
Cardiovascular: Chest pain/tightness/heaviness/pressure (1% to 2%), palpitation (1%), syncope (1%)
Central nervous system: Burning (1%), dizziness (>1%), drowsiness (>1%), malaise/fatigue (2% to 3%), headache (>1%), nonspecified pain (1% to 2%, placebo 1%), vertigo (<1% to 2%), migraine (>1%), sleepiness (>1%)
Gastrointestinal: Diarrhea (1%), nausea (>1%), vomiting (>1%), hyposalivation (>1%)
Hematologic: Hemolytic anemia (1%)
Neuromuscular & skeletal: Neck, throat, and jaw pain/tightness/pressure (2% to 3%), paresthesia (3% to 5%), myalgia (1%), numbness (1%)
Otic: Ear hemorrhage (1%), hearing loss (1%), sensitivity to noise (1%), tinnitus (1%)
Renal: Hematuria (1%)
Respiratory: Allergic rhinitis (1%), dyspnea (1%), nasal inflammation (1%), nose/throat hemorrhage (1%), sinusitis (1%), upper respiratory inflammation (1%)
Miscellaneous: Hypersensitivity reactions (1%), nonspecified pressure/tightness/heaviness (1% to 3%, placebo 2%); warm/cold sensation (2% to 3%, placebo 2%)
Route unspecified: <1%: Postmarketing and uncontrolled studies (limited to important or life-threatening): Abdominal aortic aneurysm, abdominal discomfort, abnormal menstrual cycle, abnormal/elevated liver function tests, accommodation disorders, acute renal failure, agitation, anaphylactoid reaction, anaphylaxis, anemia, angioneurotic edema, appetite decreased, arrhythmia, atrial fibrillation, bronchospasm, cardiomyopathy, cerebral ischemia, cerebrovascular accident, colonic ischemia, coronary artery vasospasm, cyanosis, deafness, dental pain, diarrhea, dyspeptic symptoms, dysphagia, dystonic reaction, ECG changes, fluid disturbances (including retention), flushing, gastrointestinal pain, hallucinations, heart block, hematuria, hemolytic anemia, hiccups, hypersensitivity reactions, hypertensive crises, hyper-/hypotension, intestinal obstruction, intracranial pressure increased, ischemic colitis, joint ache, MI, muscle stiffness, nose/throat hemorrhage, numbness of tongue, optic neuropathy (ischemic), pancytopenia, paresthesia, phlebitis, photosensitivity, Prinzmetal's angina, pruritus, psychomotor disorders, pulmonary embolism, rash, Raynaud syndrome, retinal artery occlusion, retinal vein thrombosis, seizures, sensation changes, serotonin syndrome, shock, subarachnoid hemorrhage, swallowing disorders, syncope, temporal arteritis, thrombocytopenia, thrombophlebitis, thrombosis, transaminases increased, transient myocardial ischemia, TSH increased, vasculitis, ventricular fibrillation, ventricular tachycardia, vision loss, xerostomia
Metabolism/Transport Effects
None known.
Drug Interactions
Antipsychotics: May enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome. Risk C: Monitor therapy
Ergot Derivatives: May enhance the vasoconstricting effect of Serotonin 5-HT1D Receptor Agonists. Serotonin 5-HT1D Receptor Agonists may enhance the vasoconstricting effect of Ergot Derivatives. Risk X: Avoid combination
MAO Inhibitors: May decrease the metabolism of Serotonin 5-HT1D Receptor Agonists. Management: If MAO inhibitor therapy is required, naratriptan, eletriptan or frovatriptan may be a suitable 5-HT1D agonist to employ. Risk X: Avoid combination
Metoclopramide: Serotonin Modulators may enhance the adverse/toxic effect of Metoclopramide. This may be manifest as symptoms consistent with serotonin syndrome or neuroleptic malignant syndrome. Risk C: Monitor therapy
Serotonin Modulators: May enhance the adverse/toxic effect of other Serotonin Modulators. The development of serotonin syndrome may occur. Risk D: Consider therapy modification
Storage
Alsuma™: Store at 25°C (77°F); excursions permitted between 15°C and 30°C (59°F and 86°F); do not refrigerate. Protect from light.
Imitrex® injectable, tablet, nasal spray: Store at 2°C to 30°C (36°F to 86°F). Protect from light.
Sumavel™ DosePro™: Store at 20°C to 25°C (68°F to 77°F); excursions permitted between 15°C and 30°C (59°F and 86°F); do not freeze.
Mechanism of Action
Selective agonist for serotonin (5-HT1B and 5-HT1D receptors) in cranial arteries; causes vasoconstriction and reduces neurogenic inflammation associated with antidromic neuronal transmission correlating with relief of migraine
Pharmacodynamics/Kinetics
Onset of action: Oral: ~30 minutes; Nasal: ~15-30 minutes; SubQ: ~10 minutes
Distribution: Vd: 2.4 L/kg
Protein binding: 14% to 21%
Metabolism: Hepatic, primarily via MAO-A isoenzyme; extensive first-pass metabolism following oral administration
Bioavailability: Nasal: 17% (compared to SubQ); Oral: 15%; SubQ: 97% ± 16%
Half-life elimination: ~2-2.5 hours
Time to peak, serum: Oral: 2-2.5 hours; SubQ: 12 minutes (range: 4-20 minutes)
Excretion:
Nasal spray: Urine (42% of total dose as indole acetic acid metabolite; 3% of total dose as unchanged drug)
Oral: Urine (~60% of total dose, mostly as indole acetic acid metabolite; 3% of total dose as unchanged drug); feces (~40%)
SubQ: Urine (38% of total dose as indole acetic acid metabolite; 22% of total dose as unchanged drug)
Dosage
Adults:
Oral: A single dose of 25 mg, 50 mg, or 100 mg (taken with fluids). If a satisfactory response has not been obtained at 2 hours, a second dose may be administered. Results from clinical trials show that initial doses of 50 mg and 100 mg are more effective than doses of 25 mg, and that 100 mg doses do not provide a greater effect than 50 mg and may have increased incidence of side effects. Although doses of up to 300 mg/day have been studied, the total daily dose should not exceed 200 mg. The safety of treating an average of >4 headaches in a 30-day period have not been established.
Intranasal: A single dose of 5 mg, 10 mg, or 20 mg administered in one nostril. A 10 mg dose may be achieved by administering a single 5 mg dose in each nostril. If headache returns, the dose may be repeated once after 2 hours, not to exceed a total daily dose of 40 mg. In clinical trials, a greater number of patients responded to initial doses of 20 mg versus 5 or 10 mg. The safety of treating an average of >4 headaches in a 30-day period has not been established.
SubQ: Initial: Up to 6 mg; may repeat if needed ≥1 hour after initial dose (maximum: Two 6 mg injections per 24-hour period). However, controlled clinical trials have failed to document a benefit with administration of a second 6 mg dose in nonresponders.
Elderly: Use is not recommended (due to increased potential for adverse effects).
Dosage adjustment in renal impairment: No dosage adjustments are recommended.
Dosage adjustment in hepatic impairment:
Mild-to-moderate hepatic impairment:
Oral: Bioavailability of oral sumatriptan is increased with liver disease. If treatment is needed, do not exceed single doses of 50 mg.
Nasal spray: Has not been studied in patients with hepatic impairment, however, because the spray does not undergo first-pass metabolism, levels would not be expected to be altered.
Subcutaneous: Has been studied and pharmacokinetics were not altered in patients with hepatic impairment compared to healthy patients.
Severe hepatic impairment: Oral, nasal, and subcutaneous (limited to Imitrex® injection, per prescribing information) formulations are contraindicated with severe hepatic impairment.
Administration: Oral
Should be administered as soon as symptoms appear.
Administration: Other
Should be administered as soon as symptoms appear.
Intranasal: Each nasal spray unit is preloaded with 1 dose; do not test the spray unit before use; remove unit from plastic pack when ready to use; while sitting down, gently blow nose to clear nasal passages; keep head upright and close one nostril gently with index finger; hold container with other hand, with thumb supporting bottom and index and middle fingers on either side of nozzle; insert nozzle into nostril about 1/2 inch; close mouth; take a breath through nose while releasing spray into nostril by pressing firmly on blue plunger; remove nozzle from nostril; keep head level for 10-20 seconds and gently breathe in through nose and out through mouth; do not breathe deeply
SubQ: Not for I.M. or I.V. use. Needle penetrates 1/4 inch of skin; use in areas of the body with adequate skin and subcutaneous thickness. Alsuma™ is a prefilled single-use autoinjector device.
Needleless administration (Sumavel™ DosePro™): Administer to the abdomen (>2 inches from the navel) or thigh; not for I.M. or I.V. administration. Do not administer to other areas of the body (eg, arm). Device is for single use only, discard after use; do not use if the tip of the device is tilted or broken.
Patient Education
Take at first sign of migraine attack. This drug is to be used to reduce your migraine, not to prevent or reduce the number of attacks. If using injection formulation, follow instructions for injection and disposal of needle and syringe. May cause flushing, nausea, or vomiting. Report immediately any chest tightness, pain, or pressure; pressure or tight feeling in head; balance change; muscle weakness on one side of the body; sudden eyesight change; or very nervous and excitable feeling.
Geriatric Considerations
Use is not recommended in the elderly, particularly since many elderly have cardiovascular disease which would put them at risk for cardiovascular adverse effects. Safety and efficacy in the elderly (>65 years) have not been established. Pharmacokinetic disposition is, however, similar to that in young adults.
Cardiovascular Considerations
5-HT1B/1D agonists have been associated with coronary vasospasm. These agents are contraindicated in patients with documented ischemic of vasospastic coronary artery disease. Patients with risk factors for CAD may receive these agents, provided a cardiovascular evaluation yields satisfactory evidence that the patient is free of cardiovascular disease. In patients with risk factors for CAD, administration of the initial dose in a medically staffed/equipped facility (ie, physician's office) is recommended. In addition, ECG monitoring after the initial dose should be considered. Patients who acquire risk factors for CAD, or long-term users of agents from this class of medications, should undergo periodic cardiovascular evaluation.
Dental Health: Effects on Dental Treatment
Key adverse event(s) related to dental treatment: Bad taste, dysphagia, hyposalivation (tablet), mouth/tongue discomfort (injection).
Dental Health: Vasoconstrictor/Local Anesthetic Precautions
No information available to require special precautions
Mental Health: Effects on Mental Status
Dizziness is common; may cause drowsiness
Mental Health: Effects on Psychiatric Treatment
If concomitant administration with SSRIs is warranted, monitor closely, especially at initiation and with dose increases; concomitant administration of MAO type A inhibitors is contraindicated (oral and nasal sumatriptan only).
Nursing: Physical Assessment/Monitoring
For use only with a clear diagnosis of acute migraine or cluster headaches (not for prophylaxis). Cardiovascular status should be evaluated prior to initiating medication and periodically thereafter. Evaluate carefully for use-related cautions (eg, history of, current, or risk factors for coronary heart disease; hepatic impairment; or seizure history). Monitor for hypertension, cardiac event, cerebrovascular event, dizziness, tingling, drowsiness, myalgia, vision alternation, nausea, and vomiting. With SubQ, teach patient appropriate injection technique and syringe/needle disposal.
Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Injection, solution, as succinate [strength expressed as base]: 4 mg/0.5 mL (0.5 mL); 6 mg/0.5 mL (0.5 mL)
Alsuma™: 6 mg/0.5 mL (0.5 mL) [autoinjector]
Imitrex®: 4 mg/0.5 mL (0.5 mL); 6 mg/0.5 mL (0.5 mL) [cartridge]
Imitrex®: 6 mg/0.5 mL (0.5 mL) [vial]
Sumavel™ DosePro™: 6 mg/0.5 mL (0.5 mL) [needleless autoinjector]
Injection, solution, as succinate [strength expressed as base, preservative free]: 6 mg/0.5 mL (0.5 mL)
Solution, intranasal [spray]: 5 mg/0.1 mL (6s); 20 mg/0.1 mL (6s)
Imitrex®: 5 mg/0.1 mL (6s); 20 mg/0.1 mL (6s)
Tablet, oral, as succinate [strength expressed as base]: 25 mg, 50 mg, 100 mg
Imitrex®: 25 mg, 50 mg, 100 mg
Pricing: U.S. (www.drugstore.com)
Device (Sumavel DosePro)
6 mg/0.5 mL (0.5): $105.15
Solution (Imitrex)
5 mg/ACT (1): $55.49
20 mg/ACT (6): $270.98
Solution (Imitrex STATdose Refill)
6 mg/0.5 mL (1): $217.16
Solution (Imitrex STATdose System)
6 mg/0.5 mL (1): $217.16
Solution (SUMAtriptan)
5 mg/ACT (1): $45.99
20 mg/ACT (1): $45.99
Tablets (Imitrex)
25 mg (9): $272.65
50 mg (9): $268.99
100 mg (9): $255.00
Tablets (SUMAtriptan Succinate)
25 mg (9): $219.99
50 mg (9): $199.99
100 mg (9): $205.00
Extemporaneously Prepared
A 5 mg/mL oral liquid preparation made from tablets and one of three different vehicles (Ora-Sweet®, Ora-Sweet® SF, or Syrpalta® syrups). Note: Ora-Plus® Suspending Vehicle is used with Ora-Sweet® or Ora-Sweet® SF to facilitate dispersion of the tablets (Ora-Plus® is not necessary if Syrpalta® is the vehicle). Crush nine 100 mg tablets in a mortar and reduce to a fine powder. Add 40 mL of Ora-Plus® in 5 mL increments and mix thoroughly between each addition; rinse mortar and pestle 5 times with 10 mL of Ora-Plus®, pouring into bottle each time, and add quantity of appropriate syrup (Ora-Sweet® or Ora-Sweet® SF) sufficient to make 180 mL. Store in amber glass bottles in the dark; label "shake well", "refrigerate", and "protect from light". Stable for 21 days refrigerated.
Fish DN, Beall HD, Goodwin SD, et al, "Stability of Sumatriptan Succinate in Extemporaneously Prepared Oral Liquids," Am J Health Syst Pharm, 1997, 54(14):1619-22.
References
Akpunonu BE, Mutgi AB, and Federman DJ, “Subcutaneous Sumatriptan for Treatment of Acute Migraine in Patients Admitted to the Emergency Department: A Multicenter Study,” Ann Emerg Med, 1995, 25(4):464-9.
American Academy of Pediatrics Committee on Drugs, "Transfer of Drugs and Other Chemicals Into Human Milk," Pediatrics, 2001, 108(3):776-89.
Blier P and Bergeron R, “The Safety of Concomitant Use of Sumatriptan and Antidepressant Treatments,” J Clin Psychopharmacol, 1995, 15(2):106-9.
Boyd IW and Rohan AP, “Sumatriptan - Induced Chest Pain,” Lancet, 1994, 344(8939):1704-5.
Boyer EW and Shannon M, “The Serotonin Syndrome,” New Engl J Med, 2005, 352:1112-20.
Curtin T, Brooks AP, and Roberts JA, “Cardiorespiratory Distress After Sumatriptan Given by Injection,” BMJ, 1992, 305(6855):713-4.
Diamond S, “The Use of Sumatriptan in Patients on Monoamine Oxidase Inhibitors,” Neurology, 1995, 45(6):1039-40.
Edwards KR, Bennington VT, and Ellis J, “Intracerebral Hemorrhage Associated With Sumatriptan,” Headache, 1995, 35:309.
Ilett KF, Kristensen JH, Wojnar-Horton RE, et al, “Drug Distribution in Human Milk,” Aust Prescriber, 1997, 20(2): 35-40.
Kelly KM, “Cardiac Arrest Following Use of Sumatriptan,” Neurology, 1995, 45(6):1211-3.
La Porta LD, “Recurrent Depression After Sumatriptan Administration for Treatment of Migraine,” J Clin Psychopharmacol, 1995, 15(1):81-2.
Loder E, “Safety of Sumatriptan in Pregnancy. A Review of the Data So Far,” CNS Drugs, 2003, 17(1):1-7.
Luman W and Gray RS, “Adverse Reactions Associated With Sumatriptan,” Lancet, 1993, 341(8852):1091-2.
MacDonald JT, “Treatment of Juvenile Migraine With Subcutaneous Sumatriptan,” Headache, 1994, 34(10):581-2.
Ottervanger JP, et al, “Characteristics of Sumatriptan-Induced Chest Pain,” Pharm World Sci, 1995, 17:3.
Ottervanger JP, et al, “Determinants of Sumatriptan-Induced Chest Pain,” Pharm World Sci, 1995, 17:7.
Ottervanger JP, van Witsen TB, Valkenburg HA, et al, “Adverse Reactions Attributed to Sumatriptan: A Postmarketing Study in General Practice,” Eur J Clin Pharmacol, 1994, 47(4):305-9.
Palmer J, Feldman R, Mancini GB, et al, “Glyceryl Trinitrate Reversal of Post-Sumatriptan Coronary Artery Narrowing,” Lancet, 1995, 345(8961):1366.
Reiff-Eldridge R, Heffner CR, Ephross SA, et al, “Monitoring Pregnancy Outcomes After Prenatal Drug Exposure Through Prospective Pregnancy Registries: A Pharmaceutical Company Commitment,” Am J Obstet Gynecol, 2000, 182(1 Pt 1):159-63.
Scott AK, “Sumatriptan Clinical Pharmacokinetics,” Clin Pharmacokinet, 1994, 27(5):337-44.
Srinivas NR, Igwenezue KB, Hainsworth JD, et al, “Lack of Pharmacokinetic Interaction Between Butorphanol Tartrate Nasal Spray and Sumatriptan Succinate,” J Clin Pharmacol, 1995, 35(4):432-7.
Srinivas NR, Shyu WC, Upmalis D, et al, “Lack of Pharmacokinetic Interaction Between Butorphanol Tartrate Nasal Spray and Sumatriptan Succinate,” J Clin Pharmacol, 1995, 35(4):432-7.
Stricker BH, “Coronary Vasospasm and Sumatriptan,” BMJ, 1992, 305(6845):118.
Walton-Shirley M, Flowers K, and Whiteside JH, “Unstable Angina Pectoris Associated With Imitrex Therapy,” Cathet Cardiovasc Diagn, 1995, 34(2):188.
Weidmann B, Jansen W, Bojko P, et al, “Sumatriptan-Induced Myocardial Infarction,” Intensivmedizin und Nofallmediczin, 1994, 31:353.
Wojnar-Horton RE, Hackett LP, Yapp P, et al, "Distribution and Excretion of Sumatriptan in Human Milk," Br J Clin Pharmacol, 1996, 41(3):217-21.
International Brand Names
Lexi-Comp.com
Last full review/revision March 2012
Content last modified March 2012
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