Triptan·Neurology - Migraine

Sumatriptan

Acute relief of migraine attacks (with or without aura), acute treatment of cluster headaches (SC/Nasal only)

Authority requiredPBS5HT1 AGONISTImigran50 mg tablet+2

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At a glance

Max Dose

300 mg/day (PO)

Half-life

2 h

High risk: Coronary Spasm

CRITICAL

Timing

AT ONSET

Cautions

Avoid / Cautions

Ischaemic heart disease, coronary vasospasm/Prinzmetal angina, previous MI, stroke/TIA, peripheral vascular disease, uncontrolled hypertension, severe hepatic impairment, hemiplegic/basilar/brainstem migraine, MAOIs, and ergot/triptan use within 24 hours. Pregnancy requires benefit-risk review.

Where it stands

Rapid Summary

Overview

Serotonin (5-HT1B/1D) receptor agonist. Powerful cranial vasoconstrictor. The definitive acute abortive agent for severe migraines and cluster headaches.

Clinical Focus

Never prescribe to patients with ischemic heart disease. It can trigger lethal coronary artery vasospasm and myocardial infarction.

Bottom Line

Sumatriptan is the gold-standard triptan for acute migraine relief, but is contraindicated in ischaemic heart disease and must not be used within 24 hours of ergotamines or other triptans.

Formulation & Access

Brand Names

Imigran

Oral Routes

Tablets (50 mg). Nasal spray (10 mg, 20 mg).

Parenteral

Pre-filled autoinjector pens (6 mg/0.5 mL) for SC use.

Prescribing & PBS

Authority Required (PBS).

Indications & Use

Primary

PBSTGA

Acute relief of migraine attacks (with or without aura), acute treatment of cluster headaches (SC/Nasal only).

Clinical Place

Used strictly as an abortive therapy. Useless for migraine prophylaxis.

Quick reference

Class & Role

Triptan — Serotonin (5-HT1B/1D) receptor agonist.

Route / Formulation

Tablets (50 mg). Nasal spray (10 mg, 20 mg). (Imigran)

Usual Dose & Max

PO 50 mg STAT as soon as headache begins. May repeat dose after 2 hours if migraine returns. Max 300 mg/24h.

Key Indication Doses

Acute Migraine (Oral): PO 50 mg STAT as soon as headache begins. May repeat dose after 2 hours if migraine returns. Max 300 mg/24h. Acute Migraine (Subcutaneous): SC 6 mg STAT via autoinjector. Max 12 mg/24h. (Rapid acting, bypasses GI stasis/vomiting). Cluster Headache: SC 6 mg STAT.

Best Uses

Sumatriptan is the gold-standard triptan for acute migraine relief, but is contraindicated in ischaemic heart disease and must not be used within 24 hours of ergotamines or other triptans.

Key Risks

Cardiovascular: Coronary artery vasospasm, myocardial infarction, severe hypertension, arrhythmias. Neurological: 'Triptan Sensations' (tightness, heaviness, pain or pressure in the chest, throat, and neck), dizziness, tingling. Gastrointestinal: Nausea (though the migraine itself causes this).

Key Interactions

SSRIs, SNRIs, MAOIs, Tramadol. Major risk of Serotonin Syndrome. Ergotamines (e.g., Cafergot). Risk of prolonged, severe vasospasm. Must separate by 24 hours.

Monitoring

Educate the patient that 'chest tightness' is a normal, harmless side effect of the drug's mechanism on esophageal/muscle receptors, but true crushing chest pain requires ED review. No specific routine laboratory tests required.

Clinical Pearl

Triptans do not work if taken during the 'aura' phase of a migraine. The patient must wait until the actual *headache pain* begins before taking the pill, otherwise it is wasted.

Access

Authority requiredImigran50 mg tablet

Brand: Imigran
PBS status: Authority required
Formulation: Tablets (50 mg). Nasal spray (10 mg, 20 mg).

From this page

No calculator, monitoring schedule or factsheet is linked to this medicine page yet.

Cautions

Avoid / Cautions