Stahl's Essential Psychopharmacology Online
In Collaboration With
Sumatriptan
Therapeutics
Brands
• Imitrex, Treximet, Imigran, Sumarel
Generic?
Yes, with the exception of sumatriptan/naproxen
Class
• Triptan
Commonly Prescribed for
(FDA approved in bold)
• Migraine
• Cluster headache (injection only)
How the Drug Works
• Selective
5-HT1 receptor agonist, working predominantly at the B and D receptor
subtypes. Effectiveness may be due to blocking
the transmission of pain signals
from the trigeminal nerve to the trigeminal nucleus caudalis and
preventing release of inflammatory
neuropeptides rather than just
causing vasoconstriction
• Naproxen is an NSAID (cyclo-oxygenase inhibitor) which inhibits synthesis of prostaglandins, a mediator of inflammation
How Long Until It Works
• Oral or NS- 1 hour or less. SC - within 10-30 minutes
If It Works
• Continue to take as needed. Patients taking acute treatment more than 2 days/week are at risk for medication-overuse headache,
especially if they have migraine
If It Doesn't Work
• Treat early in the attack - triptans are less likely to work after the development of cutaneous allodynia, a marker of central
sensitization
• Use SC injection instead
• For patients with partial response or reoccurrence, use sumatriptan/naproxen combination
• Change to another agent
Best Augmenting Combos for Partial Response or Treatment-Resistance
• NSAIDs or neuroleptics are often used to augment response
• Use sumatriptan/naproxen combination
Tests
• None required