Sumatriptan for migraine

Pizotifen did not alter the pharmacokinetics or pharmacodynamics of sumatriptan or zolmitriptan, and did not alter the efficacy of acute sumatriptan for migraine. It seems unlikely that any of the other triptans will interact. 

Pizotifen 500 micrograms three times daily for 8 days in 14 healthy subjects was found to have no significant effect on the pharmacokinetics of sumatriptan. In addition, there were no significant changes in blood pressure or heart rate. In a clinieal study, the addition of pizotifen prophylaxis did not alter the efficacy of acute sumatriptan for migraine relief. In this study, the eombination was assoeiated with more weight gain than sumatriptan alone, an effeet whieh was attributed solely to the pizotifen. ... 

Serotonin syndrome (sibutramine) The rare, but serious, constellation of symptoms also has been reported with the concomitant use of selective serotonin reuptake inhibitors and agents for migraine therapy (eg, sumatriptan, dihydroergotamine), certain opioids (eg, dextromethorphan, meperidine, pentazocine, fentanyl), lithium, or tryptophan. Because sibutramine inhibits serotonin reuptake, it should not be administered with other serotonergic agents. 

Alternative to sumatriptan for the treatment of migraine headache has not been compared head-to-head with sumatriptan choice should be based on cost and availability... 

The most recent treatment for migraine is a class of compounds known as the "triptans" - sumatriptan and its progeny. These seem to be about 65% effective and show fewer side effects. 

Cluster headaches may be treated with a 5HTj-receptor agonist, e.g. sumatriptan, as for migraine. Since bouts of headache tend to be of limited duration, e.g. a few weeks, short courses of methysergide are justified in intractable cases. 

Tfelt-Hansen P, Ryan RE Jr. Oral therapy for migraine comparisons between rizatriptan and sumatriptan. A review of four randomized, double-blind clinical trials. Neurology 2000 55(9 Suppl 2) S19-24. 

Kallen B, Lygner PE. Delivery outcome in women who used drugs for migraine during pregnancy with special reference to sumatriptan. Headache 2001 41(4) 351-6. 

However, this route of administration is eminently logical, in several circumstances. For the acute treatment of migraine, oral drugs are often vomited (sumatriptan). For treating acute asthma, children often cannot use an inhalational device properly (theophyliine). For perioperative antibiotics, patients are often nil by mouth (metronidazole). For inflammatory bowel disease and proctitis, this is simply a topical administration. 

Auto-injection devices have been developed for self-administration of sumatriptan for the treatment of migraine. Glaxo Wellcome has marketed such a device as Subject . 

Study and classification of serotonin receptors has resulted in the design and synthesis of highly selective medicines such as Sumatriptan, for the treatment of migraine, Ondansetron for the suppression of the nausea and vomiting caused by cancer chemotherapy and radiotherapy, and Alosetron for treatment of irritable bowel syndrome. 

Serotonin, which is an indole, occurs naturally in the body. In most cases of migraines, serotonin levels decrease. Many migraine medications are based on the indole stmcture. Sumatriptan (sold as the succinate salt by GlaxoSmithKline as IMITREX), rizatriptan (sold as the benzoate salt by Merck Co. Inc. as MAXALT), and eletiip-tan (sold as the hydrobromide salt by Pfizer Inc. as RELPAX) are all prescribed for migraines. 

Imitrex (Sumatriptan) 82 is the first selective 5-HTid agonist developed by Glaxo for the treatment of migraine. The synthesis of Imitrex has been carried out by several different routes all of which involved a Fischer indolization reaction as the key step. Outlined below is one of the synthetic routes. 

Interest in this receptor has been generated by the possibility that its activation accounts for the anti-migraine effects of the non-selective 5-HTib/id agonist, sumatriptan. The exact process(es) that account for this action are unresolved but... 

Sumatriptan succinate is effective for the treatment of acute migraine headaches by acting as... 

NSAIDs are contraindicated after 37 weeks gestation. For refractory migraines, narcotics may be used. Salicylates and indomethacin should be avoided throughout pregnancy if possible. The use of sumatriptan is controversial. Nausea of migraines may be treated with metoclopramide. 

Sumatriptan, zolmitriptan, naratriptan, rizatriptan, almotriptan, fro-vatriptan, and eletriptan are appropriate first-line therapies for patients with moderate to severe migraine or as rescue therapy when nonspecific medications are ineffective. 

Sumatriptan is a 5HT agonist, which is indicated in the treatment of acute migraine attacks. Sumatriptan may cause vasoconstriction as a side-effect and therefore its use is reserved for patients in whom other conventional migraine analgesics have failed. 

Not intended for the prophylactic therapy of migraine or for use in the management of hemiplegic or basilar migraine. Safety and efficacy have not been established for cluster headache, which is present in an older, predominantly male population (almotriptan, eletriptan, frovatriptan, sumatriptan tablets and spray, zolmitriptan). 

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