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Sumatriptan

Classification: A

Drug products: Imigran, Imigran®, Imigran® Novum, Imigrane, Oriptan®, Sumatriptan ABECE, Sumatriptan Accord, Sumatriptan Actavis, Sumatriptan Amneal, Sumatriptan Apofri, Sumatriptan Arrow, Sumatriptan Aurobindo, Sumatriptan Bluefish, Sumatriptan BMM Pharma, Sumatriptan Bristol, Sumatriptan Copyfarm, Sumatriptan EQL Pharma, Sumatriptan Mylan, Sumatriptan ratiopharm, Sumatriptan Sandoz, Sumatriptan STADA, Sumatriptan SUN, Sumatriptan Teva, Zumo

ATC code: N02CC01

Substances: sumatriptan, sumatriptan succinate

Summary

A meta-analysis has shown the effect of sumatriptan in acute migraine to be equal in men and women. Women with Horton’s headache responded less than men to treatment with sumatriptan.

A study reported men with hypertension and heredity for myocardial infarction and women with Raynaud’s syndrome to have a higher risk of sumatriptan-induced chest pain. However, a large meta-analysis showed no differences in adverse events between men and women.
 
The present evidence concerning differences between men and women is limited and do not motivate differentiation in dosing or treatment.

Additional information

Pharmacokinetics and dosing

Direct comparisons of the pharmacokinetics in men and women with migraine have not been performed. However, in a comparison of data from different studies, young men without migraine had similar pharmacokinetic profile as young women with migraine [1]. According to the original manufacturer, no pharmacokinetic sex differences in AUC, Cmax, Tmax and half-life of sumatriptan have been observed and no sex differentiation in dosing has been recommended [2].

Effects

A meta-analysis of four randomized, double-blind, placebo-controlled studies (329 men, 2066 women) analyzing efficacy and tolerability of sumatriptan, showed no sex differences in headache relief [3]. Results from the United States Cluster Headache Survey (816 men, 318 women) showed a sex difference in sumatriptan headache relief . In both men and women, the response to injectable sumatriptan was greater than the response to the nasal spray. Although 72% of women with cluster headache had a positive response to injectable sumatriptan, they were less likely to respond to sumatriptan (injectable or nasal spray) than men [4].

Adverse effects

Sumatriptan-induced chest pain was investigated in a Dutch postmarketing study (72 men, 294 women). Chest pain was more common in women than men (84% vs. 16%). Hypertension and a family history of myocardial infarction increased the risk of sumatriptan-induced chest pain in men. In women but not in men, Raynaud phenomenon was a significant risk factor [5].

In the meta-analysis mentioned above [3], incidence of adverse events was similar between men and women.

Reproductive health issues

Regarding teratogenic aspects, please consult the Drugs and Birth Defects Database (in Swedish, Janusmed fosterpåverkan).

Other information

Studies have found that sumatriptan increases plasma growth hormone in healthy men and women. Sumatriptan decreases plasma prolactin in healthy men, but not in women. This suggests that there are sex differences in the 5-HT regulation of prolactin release [6, 7].

Updated: 2019-02-26

Date of litterature search: 2014-06-04

References

  1. Scott AK. Sumatriptan clinical pharmacokinetics. Clin Pharmacokinet. 1994;27:337-44. PubMed
  2. Imitrex (sumatriptan). DailyMed [www]. US National Library of Medicine. [updated 2013-11-01, cited 2014-06-04]. länk
  3. Ashford E, Salonen R, Saiers J, Woessner M. Consistency of response to sumatriptan nasal spray across patient subgroups and migraine types. Cephalalgia. 1998;18:273-7. PubMed
  4. Rozen TD, Fishman RS. Female cluster headache in the United States of America: what are the gender differences? Results from the United States Cluster Headache Survey. J Neurol Sci. 2012;317:17-28. PubMed
  5. Ottervanger JP, Wilson JH, Stricker BH. Drug-induced chest pain and myocardial infarction Reports to a national centre and review of the literature. Eur J Clin Pharmacol. 1997;53:105-10. PubMed
  6. Boeles S, Williams C, Campling GM, Goodall EM, Cowen PJ. Sumatriptan decreases food intake and increases plasma growth hormone in healthy women. Psychopharmacology (Berl). 1997;129:179-82. PubMed
  7. Herdman JR, Delva NJ, Hockney RE, Campling GM, Cowen PJ. Neuroendocrine effects of sumatriptan. Psychopharmacology (Berl). 1994;113:561-4. PubMed
  8. Läkemedelsstatistik. Stockholm: Socialstyrelsen. 2015 [cited 2016-04-29] länk
  9. von Euler, M, Keshani, S, Baatz, K, Wettermark, B. PP261 - Utilization of triptanes in Sweden; analyses of over the counter and prescriptions sales. Clinical Therapeutics. 2013;8, Suppl(35):e99.
  10. Dahlöf C, Linde M. One-year prevalence of migraine in Sweden: a population-based study in adults. Cephalalgia. 2001;21:664-71. PubMed

Authors: Linnéa Karlsson Lind, Desirée Loikas

Reviewed by: Mia von Euler

Approved by: Karin Schenck-Gustafsson