Indications

Suma, a serotonin (5−HT1B/1D​) receptor agonist, is indicated for the acute treatment of migraine with or without aura in adults.

Limitations of Use:

• It should only be used when a clear diagnosis of migraine has been established.
• It is not for the preventative (prophylactic) therapy of migraine attacks.
• It is not indicated for the treatment of cluster headaches.

Pharmacology

Sumatriptan is an agonist for a specific vascular 5-hydroxytryptamine (5−HT) receptor subtype. This receptor is present on cranial arteries and the vasculature of the dura mater, and its activation causes vasoconstriction, which is believed to relieve migraine headache. Additionally, sumatriptan may activate 5-HT receptors on the peripheral terminals of the trigeminal nerve, further contributing to its anti-migraine effect.

Dosage

• Nasal Spray: A single dose is 10 mg. The maximum dose within a 24-hour period is 30 mg, with doses separated by at least one hour.
• Tablets: Single doses of 25, 50, or 100 mg are effective. Doses of 50 and 100 mg may have a greater effect than 25 mg, but 100 mg may not be more effective than 50 mg. The dose should be chosen on an individual basis. If the headache returns or the initial response is partial, the dose can be repeated after 2 hours, but the total daily dose should not exceed 200 mg. The safety of treating more than 4 headaches in a 30-day period has not been established.
• Children and adolescents: Sumatriptan is not recommended for patients under 18 years of age.

Administration

Nasal Spray:

1. Shake the bottle and remove the dust cap.
2. If it's the first time using it or if it hasn't been used for a week, prime the pump by pressing down on the nozzle until a fine mist appears.
3. Gently blow your nose.
4. Close one nostril and insert the applicator into the other.
5. While breathing in through your nose, press down on the white collar to release a single spray.
6. Breathe out through your mouth.
7. Repeat the steps for consecutive doses in the same or other nostril. The nasal spray should be cleaned at least once a week by washing the applicator and dust cap in warm water and allowing them to air dry.

Interaction

Suma is contraindicated for use with:

• Ergot-containing drugs.
• Monoamine Oxidase-A inhibitors (MAOIs).
• Other 5−HT1​ agonists (triptans).
• Selective Serotonin Reuptake Inhibitors (SSRIs) or Serotonin Norepinephrine Reuptake Inhibitors (SNRIs).

Contraindications

Suma is contraindicated in patients with a history of:

• Coronary artery disease or vasospasm.
• Wolff-Parkinson-White syndrome or other cardiac conduction disorders.
• Stroke, transient ischemic attack (TIA), or hemiplegic or basilar migraine.
• Peripheral vascular disease or ischemic bowel disease.
• Uncontrolled hypertension.
• Recent use (within 24 hours) of another 5−HT1​ agonist or an ergotamine-containing medication.
• Concurrent or recent use (within 2 weeks) of an MAO-A inhibitor.
• Hypersensitivity to sumatriptan.
• Severe hepatic impairment.

Side Effects

• Common: Unusual taste, pain, burning, numbness, or tingling in the nose or throat; runny or stuffy nose.
• Rare: Anxiety, general malaise or tiredness, and vision changes.

Pregnancy & Lactation

This is a Pregnancy Category C drug. There are no adequate, well-controlled studies in pregnant women. Sumatriptan is excreted in human milk. To minimize infant exposure, nursing mothers should avoid breastfeeding for 12 hours after taking the medication.

Precautions & Warnings

• Cardiac issues: Cardiac evaluation is needed for patients with multiple cardiovascular risk factors. Suma should be discontinued if arrhythmias occur.
• Serotonin syndrome: The drug should be discontinued if serotonin syndrome occurs.
• Increased blood pressure: Hypertensive crises can occur.
• Hypersensitivity reactions: Angioedema and anaphylaxis can occur.
• Seizures: Use with caution in patients with epilepsy or a lowered seizure threshold.
• Medication overuse headache: This may require detoxification.

Overdose Effects

No specific data is available on overdose with the 10 mg nasal spray.

Therapeutic Class

Suma is a 5−HT agonist.

Storage Conditions

Store between 20°C-25°C. Do not refrigerate or freeze. Do not test before use.