Sumatriptan – the beginning
The substance sumatriptan (Imigran) has been available in Germany since February 1993 and was developed specifically for the treatment of migraines for the first time. Sumatriptan is therefore also referred to as the first generation triptan.
Since the patent protection expired, bioequivalent and free-of-charge generics of sumatriptan have been on the market.
The special features of this medication are:
- It only works specifically on the parts of the body where migraine pain occurs.
- The migraine can improve after just 10 minutes (when used with the autoinjector/Glaxopen).
- It can be used as a tablet, a pre-filled syringe, a nasal spray or a suppository for self-treatment.
- To use the pre-filled syringe, a specially developed device, the so-called Glaxopen, was introduced, with which patients can independently inject the active ingredient under the skin. This enables a particularly quick onset of action.
- Good treatment success is achieved in around 86 percent of the patients treated.
- It can be given at any time during the migraine attack without loss of effectiveness, so it does not have to be used immediately at the beginning of the attack.
- Since the substance can be broken down very quickly in the body, the risk of an overdose and accumulation of the medication in the body is low.
- Although excessive use (more than 10-15 days per month) can result in a drug-induced persistent headache, compared to the old ergotamines, the symptoms of this drug-induced persistent headache are significantly milder and can usually be eliminated through outpatient withdrawal.
Sumatriptan film-coated tablets
Sumatriptan film-coated tablets are available in two dosage forms with 50 mg and 100 mg. In around 50 to 70 percent of migraine attacks, a significant improvement or even a complete disappearance of the headache can be achieved. Sumatriptan film-coated tablets should be taken as early as possible at the start of the headache phase of migraine. It takes around 30 minutes for the effect to begin. The effect reaches its maximum after 1 to 2 hours. Sumatriptan in tablet form is preferred when nausea and vomiting are only mild and the attack usually lasts four to six hours if left untreated.
Patients who have already been successfully treated with sumatriptan in tablet form should not be switched to another triptan. The starting dose of sumatriptan in tablet form is 50 mg. If this amount is sufficiently effective and the side effects are tolerable, treatment should continue with this amount of active ingredient. However, if sufficient clinical effects cannot be achieved with 50 mg, 100 mg is administered in the next attack.
If a good effect can be achieved with 50 mg, but there are debilitating side effects, half the dose of 50 mg (25 mg) can also be taken. Approximately half of the patients treated with sumatriptan in tablet form can achieve sufficient relief with good tolerability with 50 mg. Another quarter of patients achieve this result with 25 mg and another quarter only with 100 mg.
Since October 2020, it has also been available in pharmacies without a prescription in a dosage of 50 mg.
Sumatriptan as an injection
Particularly rapid effectiveness can be achieved with sumatriptan 6 mg using an autoinjector (pen). The active substance is injected from a cartridge through a fine needle under the skin (ie subcutaneously, abbreviated sc) using a ballpoint pen-like device at the push of a button. The particular advantage of this form of application is that the patient is able to do this independently at any time and anywhere. According to clinical studies, sufficient effectiveness can be achieved within around 10 minutes.
Autoinjectors currently come in different forms:
- Imigran 6 mg-sc cartridges for replacing and using with the Glaxopen
- Sumatriptan 6 mg sc Hormosan pre-filled syringe (single injector)
If a recurring headache occurs after using sumatriptan 6 mg sc, this can optionally be treated with another subcutaneous injection of sumatriptan. Alternatively, it is also possible to use a sumatriptan tablet or an antiemetic in combination with a painkiller. A particular advantage of the subcutaneous dosage form is that in the event of severe and early vomiting, the gastrointestinal tract is completely bypassed and the effect of the medication can develop unhindered even in the case of these severe accompanying disorders.
Sumatriptan as a suppository
No longer available today.
Sumatriptan as a nasal spray
A special form of administration of the migraine medication is the administration of the active ingredient via a nasal spray. For this purpose, a single-dose container for spraying into the nose was developed. There are two different dosages with 10 mg and 20 mg sumatriptan. The optimal dose in adults is 20 mg. However, for some patients, particularly those with low body weight, 10 mg may be completely sufficient.
If the pain returns, the dose can be taken again, but should be at least 2 hours apart. Sumatriptan in the form of a nasal spray also provides very rapid relief from migraine attacks. Many patients find the nasal spray more comfortable than the subcutaneous application of sumatriptan with the Glaxopen.