Sumatriptan: Uses, Side Effects, Brands, and More

More than 44 million Americans suffer from acute migraines, headaches that can create sensitivity to light and sound and cause throbbing, debilitating pain.

Migraines are caused by neurological changes in the brain, such as swollen blood vessels, that cause moderate to severe pain on one side of the head.

One of the first-line treatments for migraines are a type of medication called triptans, including sumatriptan. 

In this article, I’ll talk more about what sumatriptan is, how it works, and common side effects.

It also explains how to take sumatriptan, possible drug interactions, and frequently asked questions.

What Is Sumatriptan?

Sumatriptan is a prescription medication that belongs to a class of drugs known as triptans or selective serotonin receptor agonists.

It is available as a generic and under the brand name Imitrex.

Sumatriptan may also be combined with naproxen, an NSAID pain reliever, in a product called Treximet.

Why Is It Prescribed? 

Sumatriptan is an FDA-approved medication for the treatment of acute migraine attacks, with or without aura.

Sumatriptan is prescribed for patients who experience moderate to severe migraine pain that does not respond to over-the-counter (OTC) pain relievers alone.

It addresses pain caused by migraines, but does not prevent them or reduce the frequency of migraine episodes.

In some cases, sumatriptan may be prescribed in combination with other medications.

How Does It Work?

Migraine pain in the head is often due to dilating, or expanding, of blood vessels in the head.

This expansion can cause pressure and inflammation in the brain.

Sumatriptan is a selective serotonin receptor antagonist, meaning it works by blocking the activity of certain serotonin receptors that send pain signals to the brain.

Some of these receptors cause blood vessels in the brain to narrow, reducing the expansion that leads to migraine pain.

Sumatripan works best if taken once the painful headache stage of a migraine has begun.

It does not work if taken during the aura phase of migraine, which occurs before the headache begins. 

Side Effects

Like most medications, sumatriptan has some common side effects, though not everyone experiences them.

Tell your healthcare provider if you experience side effects from sumatriptan that are unexpected or severe.

Higher doses of sumatriptan may lead to more noticeable side effects.

Common side effects

Common side effects of sumatriptan may include:

• Burning or tingling feelings in hands or feet
• Unusual sensations
• Hot or cold sensations
• Tightness in the chest
• Tightness in the throat, jaw, or neck
• Fatigue or drowsiness
• High blood pressure
• Upset stomach
• Diarrhea

Rare & serious side effects

In rare cases, sumatriptan may cause serious adverse reactions, including:

• Spasms in coronary arteries
• Irregular heartbeat
• Heart attack
• Stroke
• Vascular problems
• Vision loss
• Raynaud’s syndrome
• Seizures
• Serotonin syndrome
• Anaphylaxis or other allergic reactions
• Medication overuse headache (MOH)

If you notice any of these severe side effects, seek immediate medical care.

Call 9-1-1 if you experience signs of heart attack or stroke, such as loss of muscle function on one side of the body, problems speaking, chest pain, or problems breathing.

How To Take Sumatriptan?

You should take sumatriptan at the first sign of a migraine.

If symptoms do not improve within a few hours, most medication formats allow for a second dose. 

Sumatriptan may be prescribed as a tablet, a nasal spray, nasal powder, or an injectable solution.

Doses are based on factors such as your age, severity of your migraine symptoms, and other medical conditions you may have.

In some cases, you may be started on a lower dose to see how you tolerate the medication.

If you tolerate the medication well, but it does not resolve your migraine pain, your doctor may prescribe a higher dose.

Always follow the dosing instructions with your prescription.

The following are general ranges for sumatriptan prescriptions.

• Oral tablets: Available as Imitrex or generic tablets, oral sumatriptan comes in 25 mg, 50 mg, and 100 mg tablets. A typical starting dosage is 25 mg. If symptoms do not improve, a second dose may be taken 2 or more hours after the first one. The maximum safe daily dose is 200 mg per day, but only take your prescription as directed.

• Nasal spray: Sumatriptan nasal spray is available in 5, 10, and 20 mg doses. Depending on your dosage, you may be instructed to spray once in one nostril, or once in each nostril.

• Nasal powder: Available as Onzetra Xsail, sumatriptan nasal powder is provided with a disposable nose piece and a reusable delivery device. Each dose contains 11 mg of sumatriptan, which may be administered once to each nostril, for a total of 22 mg.

• Injectable solution: Available as Alsuma Injection, Imitrex Injection, and Sumavel Injection, sumatriptan injectable solution is available as single dose vials, prefilled syringes, or prefilled auto-injectors. Doses may range from 4-6 mg. If symptoms come back or do not resolve after one hour, a second dose may be used. Do not use more than two 6 mg doses in a 24-hour period or more than three 4 mg doses in a 24-hour period.

Drug Interactions

There are many potential drug interactions with sumatriptan.

Sumatriptan in all formats may interact with:

• Other prescription medications
• OTC medications
• Vitamins and minerals
• Herbal supplements

Drug interactions can lead to potentially serious side effects or complications.

Your pharmacist will give you information with your prescription.

Tell your doctor or healthcare provider about all medications and supplements you are taking, including OTC medications, dietary supplements, herbal supplements, and illicit drugs.

Specific medications that have known serious interactions with sumatriptan include:

• Monoamine oxidase inhibitors (MAOIs): Taking these with sumatriptan can result in serotonin syndrome, a potentially life-threatening condition that includes symptoms like agitation, fast heart rate, sweating, hallucinations, nausea, vomiting, diarrhea, balance problems, or loss of consciousness.

• Other triptan medications: Taking sumatriptan with other triptans can increase the risk of serious side effects, such as chest pain and vascular problems.

• Ergot-containing medications: Taking dihydroergotamine and similar drugs with sumatriptan can lead to more serious side effects relating to vasoconstriction, chest pain, and cardiovascular risks.

• Tricyclic antidepressants (TCAs): Taking sumatriptan with these types of antidepressants can increase the risk of serotonin syndrome.

• Selective serotonin reuptake inhibitors (SSRIs): Taking sumatriptan with SSRI antidepressants increases the risk for serotonin syndrome. 

• Serotonin and norepinephrine reuptake inhibitors (SNRIs): Taking sumatriptan with SNRI antidepressants can cause serotonin syndrome.

• Other prescription pain medications: Taking sumatriptan with other medications used to treat head pain can actually make a headache worse or lead to more frequent headaches over time. Medication overuse headache (MOH) can become a chronic disorder on its own, so it is important to properly manage headache pain medications and to follow your prescriber’s instructions.

Warnings

Sumatriptan comes with several serious warnings.

Your medical provider will consider your health history, prescriptions, age, and other factors before prescribing sumatriptan.

Warnings associated with sumatriptan include:

• Allergic reactions: Sumatriptan can cause severe allergic reactions including hives, rash, and anaphylaxis. If you experience any type of allergic reaction while taking sumatriptan, seek emergency medical care and stop taking the medication. Do not take it again.

• Heart conditions: Sumatriptan can cause serious heart problems. You should not take sumatriptan if you have ever had a heart attack or been diagnosed with any heart condition, including: coronary artery disease, angina, arrhythmia, or uncontrolled high blood pressure.

• Cerebrovascular conditions: Sumatriptan can increase the risk of bleeding in the brain for people who already have, or may be at high risk for, certain conditions, including stroke, transient ischemic attack, hemiplegic migraine, or brain hemorrhage.

• Circulation disorders: Sumatriptan helps shrink blood vessels in the brain, and can increase the risk of vascular complications for people who have circulation problems such as peripheral vascular disease.

• Seizure disorder: If you have had or may be prone to seizures, do not take sumatriptan.

• Liver problems or liver disease: If you have liver disorders, you should not take sumatriptan. Your healthcare provider will recommend alternative medications for treating migraine pain.

• Pregnancy: Human studies on pregnant people taking sumatriptan have not shown negative effects on the fetus, but large trials have not firmly established safety. Animal studies have shown potentially negative effects, and sumatriptan is FDA class C for pregnancy. If your healthcare provider thinks the benefits outweigh the risks, sumatriptan may be used in pregnancy. Otherwise, your medical provider may prescribe a different treatment option. If you become pregnant while taking sumatriptan, tell your healthcare provider right away.

• Breastfeeding: Sumatriptan can be transferred to an infant via breast milk and cause serious side effects. People who are breastfeeding should not breastfeed a child for at least 12 hours after taking a dose of sumatriptan.

Overdose

Sumatriptan overdose is not common, but taking the medication too frequently can lead to medication overuse headache (MOH).

This can make medication less effective at treating migraine headaches or other head pain.

It can also lead to withdrawal headaches when discontinuing the medication.

Brand Names

Sumatriptan is sold under several brand names in different formulations.

• Imitrex
• Tosyma
• Onzetra Xsail
• Alsuma Injection
• Imitrex Injection
• Sumavel Injection

Sumatriptan is also paired with naproxen, an NSAID, and sold as Treximet.

Many types of sumatriptan are available in generic forms.

Alternatives

In addition to sumatriptan, other triptan drugs are available:

• Almotriptan (Axert)
• Eletriptan (Relpax)
• Frovatriptan (Frova)
• Naratriptan (Amerge)
• Rizatriptan (Maxalt)
• Zolmitriptan (Zomig)

If triptans do not work, or are not safe for you due to other medications you take or existing health conditions, there are other migraine pain relief options available, including:

• OTC pain relievers like aspirin, acetaminophen (Tylenol), ibuprofen (Advil, Motrin), naproxen (Aleve), and Excedrin

• Dihydroergotamine

• Anti-nausea drugs like chlorpromazine, metoclopramide, and others

Your medical provider will consider symptoms, migraine frequency, and pain severity to determine the appropriate medication for you.

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