Sumatriptan is a selective agonist at
serotonin 5-HT1-like receptors, including 5-HT1B/1D subtypes. It is an effective treatment for acute
migraine attacks and the
injectable form has also shown efficacy in the treatment of
cluster headaches. In placebo-controlled clinical trials,
sumatriptan, administered subcutaneously, orally, intranasally or rectally was significantly more effective than placebo in relieving
migraine headache and in producing resolution or reduction of other symptoms associated with
migraine, including
nausea,
photophobia and
phonophobia. Improvements in clinical disability were also significantly greater after
sumatriptan than after placebo.
Headache recurred in 21 to 57% of patients who received oral or subcutaneous
sumatriptan, but most patients responded to a second dose of the
drug. Results of comparative trials showed that subcutaneous
sumatriptan 6 mg was significantly more effective than either patients' usual antimigraine treatments or intranasal
dihydroergotamine mesylate 1 mg in relieving
migraine headache. Subcutaneous
sumatriptan 6 mg and subcutaneous
dihydroergotamine mesylate 1 mg provided similarly effective
migraine relief, but the
headache recurrence rate was significantly higher after
sumatriptan than after this formulation of
dihydroergotamine mesylate. Response rates achieved after oral
sumatriptan were similar to those reported
after treatment with oral
naratriptan,
rizatriptan or
lysine acetylsalicylate plus
metoclopramide. Treatment of acute
migraine attacks with oral or subcutaneous
sumatriptan leads to less loss of workplace productivity than other antimigraine
therapies. Several pharmacoeconomic analyses showed that gains in workplace productivity in
sumatriptan recipients ranged from 12.1 to 89.8 hours per patient per year. Significant improvements from baseline in overall health-related quality-of-life scores were also experienced by
sumatriptan recipients.
Sumatriptan is generally well tolerated.
Nausea,
vomiting, malaise and
fatigue are the most common adverse events with oral
sumatriptan.
Injection site reactions occur in 10 to 40% of patients receiving the
drug subcutaneously. A bitter taste at the back of the mouth occurs frequently after
intranasal administration. Serious adverse events occur in about 0.14% of patients with
migraine treated with
sumatriptan. As the
drug is associated with the rare development of cardiovascular effects, it is contraindicated in patients with a history of
cardiovascular disease.
CONCLUSIONS: Despite its relatively high acquisition cost, reductions in lost workplace productivity experienced by patients treated with
sumatriptan may result in savings in the overall cost of
migraine to society. Thus,
sumatriptan is a useful first- or second-line treatment option for patients with moderate or severe
migraine.