SUMATRIPTAN - AN UPDATED REVIEW OF ITS USE IN MIGRAINE

Sumatriptan is a selective agonist at serotonin 5-HT1-like receptors, including 5-HT1B/1D subtypes. It is an effective treatment for acute m igraine 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 re ctally was significantly more effective than placebo in relieving migr aine headache and in producing resolution or reduction of other sympto ms associated with migraine, including nausea, photophobia and phonoph obia. Improvements in clinical disability were also significantly grea ter after sumatriptan than after placebo. Headache recurred in 21 to 5 7% of patients who received oral or subcutaneous sumatriptan, but most patients responded to a second dose of the drug. Results of comparati ve trials showed that subcutaneous sumatriptan 6mg was significantly m ore effective than either patients' usual antimigraine treatments or i ntranasal dihydroergotamine mesylate 1mg in relieving migraine headach e. Subcutaneous sumatriptan 6mg and subcutaneous dihydroergotamine mes ylate 1mg provided similarly effective migraine relief, but the headac he recurrence rate was significantly higher after sumatriptan than aft er this formulation of dihydroergotamine mesylate. Response rates achi eved after oral sumatriptan were similar to those reported after treat ment with oral naratriptan, rizatriptan or lysine acetylsalicylate plu s metoclopramide. Treatment of acute migraine attacks with oral or sub cutaneous sumatriptan leads to less loss of workplace productivity tha n other antimigraine therapies. Several pharmacoeconomic analyses show ed that gains in workplace productivity in sumatriptan recipients rang ed from 12.1 to 89.8 hours per patient per year. Significant improveme nts from baseline in overall health-related quality-of-life scores wer e also experienced by sumatriptan recipients. Sumatriptan is generally well tolerated. Nausea, vomiting, malaise and fatigue are the most co mmon adverse events with oral sumatriptan. Injection site reactions oc cur in 10 to 40% of patients receiving the drug subcutaneously. A bitt er taste at the back of the mouth occurs frequently after intranasal a dministration. Serious adverse events occur in about 0.14% of patients with migraine treated with sumatriptan. As the drug is associated wit h the rare development of cardiovascular effects, it is contraindicate d in patients with a history of cardiovascular disease. Conclusions. D espite its relatively high acquisition cost, reductions in lost workpl ace productivity experienced by patients treated with sumatriptan may result in savings in the overall cost of migraine to society. Thus, su matriptan is a useful first- or second-line treatment option for patie nts with moderate or severe migraine.