Intranasal sumatriptan for the acute treatment of migraine

Salonen, R; Ashford, Elizabeth; Dahlöf, Carl; Dawson, Rachel; Gilhus, Nils Erik; Lüben, V.; Noronha, Drusilla; Warter, Jean‐Marie

doi:10.1007/bf00919706

Cited by 53 publications

(35 citation statements)

References 7 publications

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“…No other subject had a significant elevation in blood pressure during the 8‐hour observation period. A previous study of intranasal sumatriptan reported a small (3 mmHg) but statistically significant elevation in diastolic blood pressure, 13 but other studies have not reported any significant change in blood pressure 14 , 15…”

Section: Discussionmentioning

confidence: 96%

“…A previous study of intranasal sumatriptan reported a small (3 mmHg) but statistically significant elevation in diastolic blood pressure, 13 but other studies have not reported any significant change in blood pressure. 14,15 Migraine is an important clinical problem in schoolage children. By 15 years of age, about 5% of children will have had a migraine attack.…”

Section: Discussionmentioning

confidence: 99%

“…18,19 Therapeutic efficacy studies of 20 mg intranasal sumatriptan in adults with migraine indicates a response rate of about 60% to 75% compared with 30% to 40% in placebo-treated patients. 14,15 In adults, the nasal spray had a rapid onset of action, with patients experiencing headache improvement within 15 minutes, which is more rapid than seen with oral sumatriptan. 20,21 Sumatriptan nasal spray was found to provide significantly better migraine relief than placebo in a large-scale study in adolescents.…”

Section: Christensen Et Almentioning

confidence: 99%

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Pharmacokinetics of Sumatriptan Nasal Spray in Adolescents

Christensen

Mottern

Jabbour

et al. 2003

The Journal of Clinical Pharma

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Sumatriptan is a potent and selective vascular 5-HT1 receptor agonist effective for the treatment of migraine. In adults, intranasal sumatriptan is well absorbed and tolerated. The authors evaluated the pharmacokinetics and tolerability of a single dose of 20 mg intranasal sumatriptan in healthy adolescent migraineurs ages 12 to 17 years, administered outside of migraine attack. Serum sumatriptan levels were measured by high-performance liquid chromatography (HPLC) with electrochemical detection in serial samples collected over 8 hours. Physical exam, vital signs, clinical laboratory tests, and electrocardiogram measurements were monitored to assess safety and tolerability. A total of 16 subjects (10 males and 6 females) had pharmacokinetic data that could be analyzed, 2 withdrew from the study 30 and 60 minutes after dosing following the loss of venous access for blood sampling, and a bioanalysis failure resulted in loss of data from 3 subjects. Noncompartmental pharmacokinetic parameters (geometric mean and 95% confidence interval) for the remaining 16 subjects were as follows: Cmax was 13.9 (11.0, 17.6) ng/mL, AUC infinity was 57.3 (47.6, 69.0) ng/mL.h, and t1/2 was 2.0 (1.8, 2.3) hours. Population pharmacokinetic analysis for all subjects (n = 21) showed that clearance and volume of distribution increase slightly with age and body size, but the changes were minimal and would not warrant dose adjustment: CL/F was 316 L (coefficient of variance [CV] = 25%) and Vd/F was 1070 L (CV = 46%). Sumatriptan was well tolerated with only minor adverse events reported, which all resolved spontaneously. The pharmacokinetic parameters in these adolescent subjects were similar to those previously reported in adults, suggesting that adolescents should be dosed similar to adults.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Christensen Et Almentioning

confidence: 99%

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Pharmacokinetics of Sumatriptan Nasal Spray in Adolescents

Christensen

Mottern

Jabbour

et al. 2003

The Journal of Clinical Pharma

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“…The effectiveness of NSAIDs is well documented. Given orally, aspirin [44][45][46][47][48][49], ibuprofen [47,50] and diclofenac-potassium (50 and 100 mg) [51] show efficacy in the same range as oral or intranasal triptans [46,47,[51][52][53][54][55][56][57][58][59][60][61][62][63][64][65], which nonetheless are likely to be effective in non-responders to NSAIDs in view of their different mode of action [66].…”

Section: Migraine Treatment In the Edmentioning

confidence: 99%

Acute migraine in the Emergency Department: extending European principles of management

2008

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The World Health Organization (WHO) placed migraine 19th among all causes of disability (12th in women) measured in years of healthy life lost to disability (YLD). The importance of headache disorders, particularly of the primary forms, is established by their distribution worldwide, their duration (the majority being life-long conditions) and their imposition of both disability and life-style restrictions among large numbers of people. For these reasons, headache disorders should represent a public-health priority. In the Emergency Department (ED), as elsewhere, migraine is often under-diagnosed-and under-treated when it is diagnosed. The result is likely to be failure of treatment. Particular attention to diagnosis is needed in ED patients with acute headache, since there is a higher probability of secondary headache due to underlying pathologies. According to European principles of management, acute migraine treatment generally is stepwise. Of the two main steps, the first relies on symptomatic medication, preferably NSAIDs with or without antiemetics. The second step uses specific therapies, usually triptans. Modifications to routine practice are appropriate in the ED. Parenteral administration of symptomatic therapies is a preferred first choice, whilst immediate resort to triptans may be appropriate, and achieve better outcomes, in patients with severe headache and diagnostic confirmation of migraine.

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“…Sumatriptan is currently being tested by an intranasal route with efficacy up to 78% for a 20-mg dose. 29 Select patients with unilateral migraine have found intranasal administration of lidocaine (Xylocaine ® ) topical solution 4% to be an effective migraine abortive treatment. 30 A dose of 0.4 mL is instilled in the ipsilateral nostril of a patient in the supine position with head extended 45 degrees and rotated 30 degrees ipsilaterally.…”

Section: Vasoactivementioning

confidence: 99%

Practice and Economics Cost Considerations in Headache Treatment Part 2: Acute Migraine Treatment

Seggern

Adelman

1996

Headache

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Today's physician has many useful medication options available for acute migraine treatment. There is a wide cost range among these drugs and today's health care environment demands that cost be factored into the decision process. Effective migraine abortive treatment decreases the costs of repeat dosing and disability. Early use of migraine abortive medication can increase its rapidity of action and effectiveness. Adjunctive medication such as metoclopramide ($0.10) is inexpensive and may improve the effectiveness of the primary abortive medication. Over-the-counter medications such as aspirin ($0.02/325 mg), Excedrin ($0.09/tablet), ibuprofen ($0.04/200 mg), or naproxen sodium ($0.09/220 mg) are inexpensive and effective. "Triple therapy" combining metoclopramide, a nonsteroidal anti-inflammatory agent, and an ergotamine preparation may improve tolerance and effectiveness of the ergot. Locally compounded dihydroergotamine nasal spray is inexpensive ($0.78/1 mg spray). The cost of using oral sumatriptan can be almost halved by prescribing half of a 50-mg tablet. Emergency department services are expensive. Huge cost savings occur through self-controlled administration of oral, rectal, or even intramuscular narcotic medications. Oral narcotic agents such as hydromorphone ($0.42/4 mg) and meperidine ($0.92/200 mg) are generally used in inadequate doses to be effective for severe migraine. Guidelines are give for more effective use of these agents. Sophisticated comparative studies are needed to evaluate, not only the direct costs of medications, but all costs of treatment of an acute migraine attack, as well as indirect costs to the patient, family, and society.

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Intranasal sumatriptan for the acute treatment of migraine

Cited by 53 publications

References 7 publications

Pharmacokinetics of Sumatriptan Nasal Spray in Adolescents

Pharmacokinetics of Sumatriptan Nasal Spray in Adolescents

Acute migraine in the Emergency Department: extending European principles of management

Practice and Economics Cost Considerations in Headache Treatment Part 2: Acute Migraine Treatment

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