Sumatriptan – the beginning
Since February 1993, sumatriptan (Imigran) has been available in Germany; it was the first drug specifically developed for the treatment of migraines. Sumatriptan is therefore also referred to as the first-generation triptan.
Since the patent protection expired, bioequivalent and co-payment-free generic versions of sumatriptan have been available on the market.
The special features of this medication are:
- It works specifically on the areas of the body where the migraine pain originates.
- Migraine symptoms 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.
- A specially developed device, the so-called Glaxopen, was introduced for the use of the pre-filled syringe, allowing patients to independently inject the active ingredient under the skin. This enables a particularly rapid onset of action.
- A good treatment outcome is achieved in approximately 86 percent of the treated patients.
- It can be administered at any time during the migraine attack without loss of effectiveness, so it does not need to be used immediately at the beginning of the attack.
- Because the substance can be broken down very quickly in the body, the risk of overdose and accumulation of the drug in the body is low.
- Although medication-induced chronic headache can develop with overuse (more than 10-15 days per month), the symptoms of this medication-induced chronic headache are significantly milder compared to the older ergotamines and can usually be eliminated by outpatient withdrawal.
Sumatriptan film-coated tablets
Sumatriptan film-coated tablets are available in two dosage forms: 50 mg and 100 mg. In approximately 50 to 70 percent of migraine attacks, significant improvement or even complete relief of the headache can be achieved. Sumatriptan film-coated tablets should be taken as early as possible at the onset of the headache phase of a migraine. It takes about 30 minutes for the effect to begin, and the maximum effect is reached after 1 to 2 hours. Sumatriptan tablets are the preferred choice when nausea and vomiting are mild and the attack typically lasts four to six hours without treatment.
Patients who have been successfully treated with sumatriptan tablets should not be switched to another triptan. The starting dose of sumatriptan tablets is 50 mg. If this amount is sufficiently effective and the side effects are tolerable, treatment should continue with this dose. However, if sufficient clinical effect cannot be achieved with 50 mg, 100 mg should be administered at the next attack.
If a good effect is achieved with 50 mg, but bothersome side effects occur, 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 using 50 mg. Another quarter of patients achieve this result with 25 mg, and another quarter only with 100 mg.
Since October 2020, the 50 mg dosage has also been available without a prescription in pharmacies.
Sumatriptan as an injection
Sumatriptan 6 mg can be administered particularly quickly using an autoinjector (pen). This pen-like device uses a button to deliver the active ingredient from a cartridge through a fine needle under the skin (subcutaneously, abbreviated sc). The key advantage of this method is that the patient can administer the medication independently, anytime and anywhere. Clinical studies have shown that sufficient efficacy can be achieved within approximately 10 minutes.
Autoinjectors are currently available in different forms:
- Imigran 6 mg subcutaneous cartridges for replacement and use with the Glaxopen
- Sumatriptan 6 mg subcutaneously, Hormosan pre-filled syringe (single-use injector)
Should a recurring headache occur after administration of sumatriptan 6 mg subcutaneously, it can optionally be treated with another subcutaneous injection of sumatriptan. Alternatively, a sumatriptan tablet or an antiemetic in combination with a pain reliever can also be used. A particular advantage of the subcutaneous route of administration is that, in cases of severe and early vomiting, the gastrointestinal tract is completely bypassed, allowing the medication to exert its effect unimpeded even in these serious accompanying symptoms.
Sumatriptan as suppositories
No longer available today.
Sumatriptan as a nasal spray
A special dosage form of the migraine medication is the administration of the active ingredient via a nasal spray. A single-dose container for nasal spray has been developed for this purpose. It is available in two different dosages: 10 mg and 20 mg of sumatriptan. The optimal dose for adults is 20 mg. However, for some patients, particularly those with low body weight, 10 mg may be perfectly sufficient.
If the pain recurs, the dose can be taken again, but a minimum interval of 2 hours should be observed. Sumatriptan in the form of a nasal spray also leads to very rapid relief of a migraine attack. Many patients find the nasal spray more comfortable than the subcutaneous administration of sumatriptan with Glaxopen.