Sumatriptan
Tablet · Oral, Subcutaneous, Nasal
Uses
Sumatriptan Nasal Spray is indicated for the acute treatment of migraine with or without aura in adults. Limitations of Use:
• Use only if a clear diagnosis of migraine headache has been established. If a patient has no response to the first migraine attack treated with Sumatriptan Nasal Spray, reconsider the diagnosis of migraine before Sumatriptan Nasal Spray is administered to treat any subsequent attacks.
• Sumatriptan is not indicated for the prevention of migraine attacks.
• Safety and effectiveness of Sumatriptan Nasal Spray have not been established for cluster headache. Sumatriptan is a serotonin (5-HT 1B/1D ) receptor agonist (triptan) indicated for acute treatment of migraine with or without aura in adults. ( 1 ) Limitations of Use:
• Use only if a clear diagnosis of migraine headache has been established. ( 1 )
• Not indicated for the prophylactic therapy of migraine attacks. ( 1 )
• Not indicated for the treatment of cluster headache. ( 1 )
Dosage and administration
The recommended adult dose of Sumatriptan Nasal Spray for the acute treatment of migraine is 5 mg, 10 mg, or 20 mg. The 20-mg dose may provide a greater effect than the 5-mg and 10-mg doses, but may have a greater risk of adverse reactions [see Clinical Studies ( 14 )] . The 5-mg and 20-mg doses are given as a single spray in 1 nostril. The 10-mg dose may be achieved by the administration of a single 5-mg dose in each nostril. If the migraine has not resolved by 2 hours after taking Sumatriptan Nasal Spray, or returns after a transient improvement, 1 additional dose may be administered at least 2 hours after the first dose. The maximum daily dose is 40 mg in a 24-hour period. The safety of treating an average of more than 4 headaches in a 30‑day period has not been established.
• Single dose of 5 mg, 10 mg, or 20 mg of nasal spray. ( 2 )
• A second dose should only be considered if some response to the first dose was observed. Separate doses by at least 2 hours. ( 2 )
• Maximum dose in a 24-hour period: 40 mg. ( 2 )
Dosage forms and strengths
Unit dose nasal spray devices containing 5 mg or 20 mg sumatriptan. Nasal spray: 5 mg and 20 mg ( 3 , 16 )
Contraindications
Sumatriptan Nasal Spray is contraindicated in patients with:
• Ischemic coronary artery disease (CAD) (angina pectoris, history of myocardial infarction, or documented silent ischemia) or coronary artery vasospasm, including Prinzmetal’s angina [see Warnings and Precautions ( 5.1 )]
• Wolff-Parkinson-White syndrome or arrhythmias associated with other cardiac accessory conduction pathway disorders [see Warnings and Precautions ( 5.2 )]
• History of stroke, transient ischemic attack (TIA), or history of hemiplegic or basilar migraine because these patients are at a higher risk of stroke [see Warnings and Precautions ( 5.4 )]
• Peripheral vascular disease [see Warnings and Precautions ( 5.5 )]
• Ischemic bowel disease [see Warnings and Precautions ( 5.5 )]
• Uncontrolled hypertension [see Warnings and Precautions ( 5.8 )]
• Recent use (i.e., within 24 hours) of ergotamine-containing medication, ergot-type medication (such as dihydroergotamine or methysergide), or another 5-hydroxytryptamine 1 (5-HT 1 ) agonist [see Drug Interactions ( 7.1 , 7.3 )]
• Concurrent administration of a monoamine oxidase (MAO)-A inhibitor or recent (within 2 weeks) use of an MAO-A inhibitor [see Drug Interactions ( 7.2 ), Clinical Pharmacology ( 12.3 )]
• Hypersensitivity to sumatriptan (angioedema and anaphylaxis seen) [see Warnings and Precautions ( 5.10 )]
• Severe hepatic impairment [see Clinical Pharmacology ( 12.3 )]
• History of coronary artery disease or coronary artery vasospasm ( 4 )
• Wolff-Parkinson-White syndrome or other cardiac accessory conduction pathway disorders ( 4 )
• History of stroke, transient ischemic attack, or hemiplegic or basilar migraine ( 4 )
• Peripheral vascular disease ( 4 )
• Ischemic bowel disease ( 4 )
• Uncontrolled hypertension ( 4 )
• Recent (within 24 hours) use of another 5-HT 1 agonist (e.g., another triptan) or of an ergotamine-containing medication. ( 4 )
• Concurrent or recent (past 2 weeks) use of monoamine oxidase-A inhibitor. ( 4 )
• Hypersensitivity to sumatriptan (angioedema and anaphylaxis seen). ( 4 )
• Severe hepatic impairment ( 4 )
Warnings and precautions
• Myocardial ischemia/infarction and Prinzmetal’s angina: Perform cardiac evaluation in patients with multiple cardiovascular risk factors. ( 5.1 )
• Arrhythmias: Discontinue Sumatriptan Nasal Spray if occurs. ( 5.2 )
• Chest/throat/neck/jaw pain, tightness, pressure, or heaviness: Generally not associated with myocardial ischemia; evaluate for coronary artery disease in patients at high risk. ( 5.3 )
• Cerebral hemorrhage, subarachnoid hemorrhage, and stroke: Discontinue Sumatriptan Nasal Spray if occurs. ( 5.4 )
• Gastrointestinal ischemic reactions and peripheral vasospastic reactions: Discontinue Sumatriptan Nasal Spray if occurs. ( 5.5 )
• Medication overuse headache: Detoxification may be necessary. ( 5.6 )
• Serotonin syndrome: Discontinue Sumatriptan Nasal Spray if occurs. ( 5.7 )
• Seizures: Use with caution in patients with epilepsy or a lowered seizure threshold. ( 5.11 ) 5.1 Myocardial Ischemia, Myocardial Infarction, and Prinzmetal’s Angina The use of Sumatriptan Nasal Spray is contraindicated in patients with ischemic or vasospastic CAD. There have been rare reports of serious cardiac adverse reactions, including acute myocardial infarction, occurring within a few hours following administration of Sumatriptan Nasal Spray. Some of these reactions occurred in patients without known CAD. Sumatriptan Nasal Spray may cause coronary artery vasospasm (Prinzmetal’s angina), even in patients without a history of CAD. Perform a cardiovascular evaluation in triptan-naive patients who have multiple cardiovascular risk factors (e.g., increased age, diabetes, hypertension, smoking, obesity, strong family history of CAD) prior to receiving Sumatriptan Nasal Spray. If there is evidence of CAD or coronary artery vasospasm, Sumatriptan Nasal Spray is contraindicated. For patients with multiple cardiovascular risk factors who have a negative cardiovascular evaluation, consider administering the first dose of Sumatriptan Nasal Spray in a medically supervised setting and performing an electrocardiogram (ECG) immediately following administration of Sumatriptan Nasal Spray. For such patients, consider periodic cardiovascular evaluation in intermittent long-term users of Sumatriptan Nasal Spray. 5.2 Arrhythmias Life-threatening disturbances of cardiac rhythm, including ventricular tachycardia and ventricular fibrillation leading to death, have been reported within a few hours following the administration of 5-HT 1 agonists. Discontinue Sumatriptan Nasal Spray if these disturbances occur. Sumatriptan Nasal Spray is contraindicated in patients with Wolff-Parkinson-White syndrome or arrhythmias associated with other cardiac accessory conduction pathway disorders. 5.3 Chest, Throat, Neck, and/or Jaw Pain/Tightness/Pressure Sensations of tightness, pain, pressure, and heaviness in the precordium, throat, neck, and jaw may occur after treatment with Sumatriptan Nasal Spray and are usually non-cardiac in origin. However, perform a cardiac evaluation if these patients are at high cardiac risk. The use of Sumatriptan Nasal Spray is contraindicated in patients with CAD and those with Prinzmetal’s variant angina. 5.4 Cerebrovascular Events Cerebral hemorrhage, subarachnoid hemorrhage, and stroke have occurred in patients treated with 5-HT 1 agonists, and some have resulted in fatalities. In a number of cases, it appears possible that the cerebrovascular events were primary, the 5-HT 1 agonist having been administered in the incorrect belief that the symptoms experienced were a consequence of migraine when they were not. Also, patients with migraine may be at increased risk of certain cerebrovascular events (e.g., stroke, hemorrhage, TIA). Discontinue Sumatriptan Nasal Spray if a cerebrovascular event occurs. Before treating headaches in patients not previously diagnosed as migraineurs, and in migraineurs who present with atypical symptoms, exclude other potentially serious neurological conditions. Sumatriptan Nasal Spray is contraindicated in patients with a history of stroke or TIA. 5.5 Other Vasospasm Reactions Sumatriptan Nasal Spray may cause non-coronary vasospastic reactions, such as peripheral vascular ischemia, gastrointestinal vascular ischemia and infarction (presenting with abdominal pain and bloody diarrhea), splenic infarction, and Raynaud’s syndrome. In patients who experience symptoms or signs suggestive of non-coronary vasospasm reaction following the use of any 5-HT 1 agonist, rule out a vasospastic reaction before using additional Sumatriptan Nasal Spray. Reports of transient and permanent blindness and significant partial vision loss have been reported with the use of 5‑HT 1 agonists. Since visual disorders may be part of a migraine attack, a causal relationship between these events and the use of 5-HT 1 agonists has not been clearly established. 5.6 Medication Overuse Headache Overuse of acute migraine drugs (e.g., ergotamine, triptans, opioids, or combination of these drugs for 10 or more days per month) may lead to exacerbation of headache (medication overuse headache). Medication overuse headache may present as migraine-like daily headaches or as a marked increase in frequency of migraine attacks. Detoxification of patients, including withdrawal of the overused drugs, and treatment of withdrawal symptoms (which often includes a transient worsening of headache) may be necessary. 5.7 Serotonin Syndrome Serotonin syndrome may occur with Sumatriptan Nasal Spray, particularly during coadministration with selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), and MAO inhibitors [see Drug Interactions ( 7.4 )] .
Side effects
The following adverse reactions are discussed in more detail in other sections of the prescribing information:
• Myocardial ischemia, myocardial infarction, and Prinzmetal’s angina [see Warnings and Precautions ( 5.1 )]
• Arrhythmias [see Warnings and Precautions ( 5.2 )]
• Chest, throat, neck, and/or jaw pain/tightness/pressure [see Warnings and Precautions ( 5.3 )]
• Cerebrovascular events [see Warnings and Precautions ( 5.4 )]
• Other vasospasm reactions [see Warnings and Precautions ( 5.5 )]
• Medication overuse headache [see Warnings and Precautions ( 5.6 )]
• Serotonin syndrome [see Warnings and Precautions ( 5.7 )]
• Increase in blood pressure [see Warnings and Precautions ( 5.8 )]
• Local irritation [see Warnings and Precautions ( 5.9 )]
• Hypersensitivity reactions [see Contraindications ( 4 ), Warnings and Precautions ( 5.10 )]
• Seizures [see Warnings and Precautions ( 5.11 )] Most common adverse reactions (≥1% and >placebo) were burning sensation, disorder/discomfort of nasal cavity/sinuses, throat discomfort, nausea and/or vomiting, bad/unusual taste, and dizziness/vertigo. ( 6.1 ) To report SUSPECTED ADVERSE REACTIONS, contact Prasco Laboratories at 1-866-525-0688 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. 6.1 Clinical Trials Experience Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared with rates in the clinical trials of another drug and may not reflect the rates observed in practice. Table 1 lists adverse reactions that occurred in worldwide placebo-controlled clinical trials in 3,419 patients with migraine. Only treatment-emergent adverse reactions that occurred at a frequency of 1% or more in the group treated with Sumatriptan Nasal Spray 20 mg and that occurred at a frequency greater than the placebo group are included in Table 1 . Table 1. Adverse Reactions Reported by at Least 1% of Patients and at a Greater Frequency than Placebo in Controlled Migraine Clinical Trials Adverse Reaction Percent of Patients Reporting Sumatriptan Nasal Spray 5 mg (n = 496) Sumatriptan Nasal Spray 10 mg (n = 1,007) Sumatriptan Nasal Spray 20 mg (n = 1,212) Placebo (n = 704) Atypical sensations Burning sensation 0.4 0.6 1.4 0.1 Ear, nose, and throat Disorder/discomfort of nasal cavity/sinuses 2.8 2.5 3.8 2.4 Throat discomfort 0.8 1.8 2.4 0.9 Gastrointestinal Nausea and/or vomiting 12.2 11.0 13.5 11.3 Neurological Bad/unusual taste 13.5 19.3 24.5 1.7 Dizziness/vertigo 1.0 1.7 1.4 0.9 The incidence of adverse reactions in controlled clinical trials was not affected by gender, weight, or age of the patients; use of prophylactic medications; or presence of aura. There were insufficient data to assess the impact of race on the incidence of adverse reactions. 6.2 Postmarketing Experience The following adverse reactions have been identified during postapproval use of sumatriptan tablets, sumatriptan nasal spray, and sumatriptan injection. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. These reactions have been chosen for inclusion due to either their seriousness, frequency of reporting, or causal connection to sumatriptan or a combination of these factors. Cardiovascular Hypotension, palpitations. Neurological Dystonia, tremor. Reproductive System and Breast Disorders Breast pain [see Use in Specific Populations ( 8.2 )] .
Drug interactions
7.1 Ergot-Containing Drugs Ergot-containing drugs have been reported to cause prolonged vasospastic reactions. Because these effects may be additive, use of ergotamine-containing or ergot-type medications (like dihydroergotamine or methysergide) and Sumatriptan Nasal Spray within 24 hours of each other is contraindicated. 7.2 Monoamine Oxidase-A Inhibitors MAO-A inhibitors increase systemic exposure by up to 7-fold. Therefore, the use of Sumatriptan Nasal Spray in patients receiving MAO-A inhibitors is contraindicated [see Clinical Pharmacology ( 12.3 )] . 7.3 Other 5-HT 1 Agonists Because their vasospastic effects may be additive, coadministration of Sumatriptan Nasal Spray and other 5-HT 1 agonists (e.g., triptans) within 24 hours of each other is contraindicated. 7.4 Selective Serotonin Reuptake Inhibitors/Serotonin Norepinephrine Reuptake Inhibitors and Serotonin Syndrome Cases of serotonin syndrome have been reported during coadministration of triptans and SSRIs, SNRIs, TCAs, and MAO inhibitors [see Warnings and Precautions ( 5.7 )] .
Use in specific populations
Pregnancy: Based on animal data, may cause fetal harm. ( 8.1 ) 8.1 Pregnancy Risk Summary Data from a prospective pregnancy exposure registry and epidemiological studies of pregnant women have not detected an increased frequency of birth defects or a consistent pattern of birth defects among women exposed to sumatriptan compared with the general population (see Data) . In developmental toxicity studies in rats and rabbits, oral administration of sumatriptan to pregnant animals was associated with embryolethality, fetal abnormalities, and pup mortality. When administered by the intravenous route to pregnant rabbits, sumatriptan was embryolethal (see Data ). In the U.S. general population, the estimated background risk of major birth defects and of miscarriage in clinically recognized pregnancies is 2% to 4% and 15% to 20%, respectively. The reported rate of major birth defects among deliveries to women with migraine ranged from 2.2% to 2.9% and the reported rate of miscarriage was 17%, which were similar to rates reported in women without migraine. Clinical Considerations Disease-Associated Maternal and/or Embryo/Fetal Risk: Several studies have suggested that women with migraine may be at increased risk of preeclampsia during pregnancy. Data Human Data: The Sumatriptan/Naratriptan/TREXIMET (sumatriptan and naproxen sodium) Pregnancy Registry, a population-based international prospective study, collected data for sumatriptan from January 1996 to September 2012. The Registry documented outcomes of 626 infants and fetuses exposed to sumatriptan during pregnancy (528 with earliest exposure during the first trimester, 78 during the second trimester, 16 during the third trimester, and 4 unknown). The occurrence of major birth defects (excluding fetal deaths and induced abortions without reported defects and all spontaneous pregnancy losses) during first-trimester exposure to sumatriptan was 4.2% (20/478 [95% CI: 2.6% to 6.5%]) and during any trimester of exposure was 4.2% (24/576 [95% CI: 2.7% to 6.2%]). The sample size in this study had 80% power to detect at least a 1.73- to 1.91-fold increase in the rate of major malformations. The number of exposed pregnancy outcomes accumulated during the registry was insufficient to support definitive conclusions about overall malformation risk or for making comparisons of the frequencies of specific birth defects. Of the 20 infants with reported birth defects after exposure to sumatriptan in the first trimester, 4 infants had ventricular septal defects, including one infant who was exposed to both sumatriptan and naratriptan, and 3 infants had pyloric stenosis. No other birth defect was reported for more than 2 infants in this group. In a study using data from the Swedish Medical Birth Register, live births to women who reported using triptans or ergots during pregnancy were compared with those of women who did not. Of the 2,257 births with first-trimester exposure to sumatriptan, 107 infants were born with malformations (relative risk 0.99 [95% CI: 0.91 to 1.21]). A study using linked data from the Medical Birth Registry of Norway to the Norwegian Prescription Database compared pregnancy outcomes in women who redeemed prescriptions for triptans during pregnancy, as well as a migraine disease comparison group who redeemed prescriptions for sumatriptan before pregnancy only, compared with a population control group. Of the 415 women who redeemed prescriptions for sumatriptan during the first trimester, 15 had infants with major congenital malformations (OR 1.16 [95% CI: 0.69 to 1.94]) while for the 364 women who redeemed prescriptions for sumatriptan before, but not during, pregnancy, 20 had infants with major congenital malformations (OR 1.83 [95% CI: 1.17 to 2.88]), each compared with the population comparison group. Additional smaller observational studies evaluating use of sumatriptan during pregnancy have not suggested an increased risk of teratogenicity. Animal Data: Oral administration of sumatriptan to pregnant rats during the period of organogenesis resulted in an increased incidence of fetal blood vessel (cervicothoracic and umbilical) abnormalities. The highest no-effect dose for embryofetal developmental toxicity in rats was 60 mg/kg/day. Oral administration of sumatriptan to pregnant rabbits during the period of organogenesis resulted in increased incidences of embryolethality and fetal cervicothoracic vascular and skeletal abnormalities. Intravenous administration of sumatriptan to pregnant rabbits during the period of organogenesis resulted in an increased incidence of embryolethality. The highest oral and intravenous no-effect doses for developmental toxicity in rabbits were 15 and 0.75 mg/kg/day, respectively. Oral administration of sumatriptan to rats prior to and throughout gestation resulted in embryofetal toxicity (decreased body weight, decreased ossification, increased incidence of skeletal abnormalities). The highest no-effect dose was 50 mg/kg/day. In offspring of pregnant rats treated orally with sumatriptan during organogenesis, there was a decrease in pup survival. The highest no-effect dose for this effect was 60 mg/kg/day. Oral treatment of pregnant rats with sumatriptan during the latter part of gestation and throughout lactation resulted in a decrease in pup survival. The highest no-effect dose for this finding was 100 mg/kg/day. 8.2 Lactation Risk Summary Sumatriptan is excreted in human milk following subcutaneous administration. There is no information regarding sumatriptan concentrations in milk from lactating women following administration of Sumatriptan Nasal Spray. There are no data on the effects of sumatriptan on the breastfed infant or the effects of sumatriptan on milk production. Use of sumatriptan may be associated with transient breast pain [see Adverse Reactions ( 6.2 )] .
Pregnancy
8.1 Pregnancy Risk Summary Data from a prospective pregnancy exposure registry and epidemiological studies of pregnant women have not detected an increased frequency of birth defects or a consistent pattern of birth defects among women exposed to sumatriptan compared with the general population (see Data) . In developmental toxicity studies in rats and rabbits, oral administration of sumatriptan to pregnant animals was associated with embryolethality, fetal abnormalities, and pup mortality. When administered by the intravenous route to pregnant rabbits, sumatriptan was embryolethal (see Data ). In the U.S. general population, the estimated background risk of major birth defects and of miscarriage in clinically recognized pregnancies is 2% to 4% and 15% to 20%, respectively. The reported rate of major birth defects among deliveries to women with migraine ranged from 2.2% to 2.9% and the reported rate of miscarriage was 17%, which were similar to rates reported in women without migraine. Clinical Considerations Disease-Associated Maternal and/or Embryo/Fetal Risk: Several studies have suggested that women with migraine may be at increased risk of preeclampsia during pregnancy. Data Human Data: The Sumatriptan/Naratriptan/TREXIMET (sumatriptan and naproxen sodium) Pregnancy Registry, a population-based international prospective study, collected data for sumatriptan from January 1996 to September 2012. The Registry documented outcomes of 626 infants and fetuses exposed to sumatriptan during pregnancy (528 with earliest exposure during the first trimester, 78 during the second trimester, 16 during the third trimester, and 4 unknown). The occurrence of major birth defects (excluding fetal deaths and induced abortions without reported defects and all spontaneous pregnancy losses) during first-trimester exposure to sumatriptan was 4.2% (20/478 [95% CI: 2.6% to 6.5%]) and during any trimester of exposure was 4.2% (24/576 [95% CI: 2.7% to 6.2%]). The sample size in this study had 80% power to detect at least a 1.73- to 1.91-fold increase in the rate of major malformations. The number of exposed pregnancy outcomes accumulated during the registry was insufficient to support definitive conclusions about overall malformation risk or for making comparisons of the frequencies of specific birth defects. Of the 20 infants with reported birth defects after exposure to sumatriptan in the first trimester, 4 infants had ventricular septal defects, including one infant who was exposed to both sumatriptan and naratriptan, and 3 infants had pyloric stenosis. No other birth defect was reported for more than 2 infants in this group. In a study using data from the Swedish Medical Birth Register, live births to women who reported using triptans or ergots during pregnancy were compared with those of women who did not. Of the 2,257 births with first-trimester exposure to sumatriptan, 107 infants were born with malformations (relative risk 0.99 [95% CI: 0.91 to 1.21]). A study using linked data from the Medical Birth Registry of Norway to the Norwegian Prescription Database compared pregnancy outcomes in women who redeemed prescriptions for triptans during pregnancy, as well as a migraine disease comparison group who redeemed prescriptions for sumatriptan before pregnancy only, compared with a population control group. Of the 415 women who redeemed prescriptions for sumatriptan during the first trimester, 15 had infants with major congenital malformations (OR 1.16 [95% CI: 0.69 to 1.94]) while for the 364 women who redeemed prescriptions for sumatriptan before, but not during, pregnancy, 20 had infants with major congenital malformations (OR 1.83 [95% CI: 1.17 to 2.88]), each compared with the population comparison group. Additional smaller observational studies evaluating use of sumatriptan during pregnancy have not suggested an increased risk of teratogenicity. Animal Data: Oral administration of sumatriptan to pregnant rats during the period of organogenesis resulted in an increased incidence of fetal blood vessel (cervicothoracic and umbilical) abnormalities. The highest no-effect dose for embryofetal developmental toxicity in rats was 60 mg/kg/day. Oral administration of sumatriptan to pregnant rabbits during the period of organogenesis resulted in increased incidences of embryolethality and fetal cervicothoracic vascular and skeletal abnormalities. Intravenous administration of sumatriptan to pregnant rabbits during the period of organogenesis resulted in an increased incidence of embryolethality. The highest oral and intravenous no-effect doses for developmental toxicity in rabbits were 15 and 0.75 mg/kg/day, respectively. Oral administration of sumatriptan to rats prior to and throughout gestation resulted in embryofetal toxicity (decreased body weight, decreased ossification, increased incidence of skeletal abnormalities). The highest no-effect dose was 50 mg/kg/day. In offspring of pregnant rats treated orally with sumatriptan during organogenesis, there was a decrease in pup survival. The highest no-effect dose for this effect was 60 mg/kg/day. Oral treatment of pregnant rats with sumatriptan during the latter part of gestation and throughout lactation resulted in a decrease in pup survival. The highest no-effect dose for this finding was 100 mg/kg/day.
Pediatric use
8.4 Pediatric Use Safety and effectiveness in pediatric patients have not been established. Sumatriptan Nasal Spray is not recommended for use in patients younger than 18 years of age. Two controlled clinical trials evaluated Sumatriptan Nasal Spray (5 to 20 mg) in 1,248 adolescent migraineurs aged 12 to 17 years who treated a single attack. The trials did not establish the efficacy of Sumatriptan Nasal Spray compared with placebo in the treatment of migraine in adolescents. Adverse reactions observed in these clinical trials were similar in nature to those reported in clinical trials in adults. Five controlled clinical trials (2 single-attack trials, 3 multiple-attack trials) evaluating oral sumatriptan (25 to 100 mg) in pediatric patients aged 12 to 17 years enrolled a total of 701 adolescent migraineurs. These trials did not establish the efficacy of oral sumatriptan compared with placebo in the treatment of migraine in adolescents. Adverse reactions observed in these clinical trials were similar in nature to those reported in clinical trials in adults. The frequency of all adverse reactions in these patients appeared to be both dose- and age-dependent, with younger patients reporting reactions more commonly than older adolescents. Postmarketing experience documents that serious adverse reactions have occurred in the pediatric population after use of subcutaneous, oral, and/or intranasal sumatriptan. These reports include reactions similar in nature to those reported rarely in adults, including stroke, visual loss, and death. A myocardial infarction has been reported in a 14‑year‑old male following the use of oral sumatriptan; clinical signs occurred within 1 day of drug administration. Clinical data to determine the frequency of serious adverse reactions in pediatric patients who might receive subcutaneous, oral, or intranasal sumatriptan are not presently available.
Geriatric use
8.5 Geriatric Use Clinical trials of Sumatriptan Nasal Spray did not include sufficient numbers of patients aged 65 years and older to determine whether they respond differently from younger patients. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function and of concomitant disease or other drug therapy. A cardiovascular evaluation is recommended for geriatric patients who have other cardiovascular risk factors (e.g., diabetes, hypertension, smoking, obesity, strong family history of CAD) prior to receiving Sumatriptan Nasal Spray [see Warnings and Precautions ( 5.1 )] .
Overdosage
In clinical trials, the highest single doses of Sumatriptan Nasal Spray administered without significant reactions were 40 mg to 12 volunteers and 40 mg to 85 subjects with migraine, which is twice the highest single recommended dose. In addition, 12 volunteers were administered a total daily dose of 60 mg (20 mg 3 times daily) for 3.5 days without significant adverse reactions. Overdose in animals has been fatal and has been heralded by convulsions, tremor, paralysis, inactivity, ptosis, erythema of the extremities, abnormal respiration, cyanosis, ataxia, mydriasis, salivation, and lacrimation. The elimination half‑life of sumatriptan is approximately 2 hours [see Clinical Pharmacology ( 12.3 )] , and therefore monitoring of patients after overdose with Sumatriptan Nasal Spray should continue for at least 10 hours or while symptoms or signs persist. It is unknown what effect hemodialysis or peritoneal dialysis has on the serum concentrations of sumatriptan.
Description
Sumatriptan Nasal Spray contains sumatriptan, a selective 5-HT 1B/1D receptor agonist. Sumatriptan is chemically designated as 3-[2-(dimethylamino)ethyl]-N-methyl-indole-5-methanesulfonamide, and it has the following structure: The empirical formula is C 14 H 21 N 3 O 2 S, representing a molecular weight of 295.4. Sumatriptan is a white to off-white powder that is readily soluble in water and in saline. Each Sumatriptan Nasal Spray contains 5 or 20 mg of sumatriptan in a 100-mcL unit dose aqueous buffered solution containing monobasic potassium phosphate NF, anhydrous dibasic sodium phosphate USP, sulfuric acid NF, sodium hydroxide NF, and purified water USP. The pH of the solution is approximately 5.5. The osmolality of the solution is 372 or 742 mOsmol for the 5- and 20-mg Sumatriptan Nasal Spray, respectively. Sumatriptan chemical structure
Mechanism of action
12.1 Mechanism of Action Sumatriptan binds with high affinity to human cloned 5-HT 1B/1D receptors. Sumatriptan presumably exerts its therapeutic effects in the treatment of migraine headache through agonist effects at the 5‑HT 1B/1D receptors on intracranial blood vessels and sensory nerves of the trigeminal system, which result in cranial vessel constriction and inhibition of pro-inflammatory neuropeptide release.
How supplied
Sumatriptan Nasal Spray 5 mg (NDC 66993-081-69) and 20 mg (NDC 66993-082-69) are each supplied in boxes of 6 nasal spray devices. Each unit dose spray supplies 5 mg and 20 mg, respectively, of sumatriptan. Store between 2°C and 30°C (36°F and 86°F). Protect from light.
Patient information
Advise the patient to read the FDA-approved patient labeling (Patient Information and Instructions for Use). Risk of Myocardial Ischemia and/or Infarction, Prinzmetal’s Angina, Other Vasospasm-Related Events, Arrhythmias, and Cerebrovascular Events Inform patients that Sumatriptan Nasal Spray may cause serious cardiovascular side effects such as myocardial infarction or stroke. Although serious cardiovascular events can occur without warning symptoms, patients should be alert for the signs and symptoms of chest pain, shortness of breath, irregular heartbeat, significant rise in blood pressure, weakness, and slurring of speech and should ask for medical advice if any indicative sign or symptoms are observed. Apprise patients of the importance of this follow-up [see Warnings and Precautions ( 5.1 , 5.2 , 5.4 , 5.5 , 5.8 )] . Anaphylactic/Anaphylactoid Reactions Inform patients that anaphylactic/anaphylactoid reactions have occurred in patients receiving Sumatriptan Nasal Spray. Such reactions can be life-threatening or fatal. In general, anaphylactic reactions to drugs are more likely to occur in individuals with a history of sensitivity to multiple allergens [see Contraindications ( 4 ), Warnings and Precautions ( 5.10 )] . Concomitant Use with Other Triptans or Ergot Medications Inform patients that use of Sumatriptan Nasal Spray within 24 hours of another triptan or an ergot-type medication (including dihydroergotamine or methysergide) is contraindicated [see Contraindications ( 4 ), Drug Interactions ( 7.1 , 7.3 )] . Serotonin Syndrome Caution patients about the risk of serotonin syndrome with the use of Sumatriptan Nasal Spray or other triptans, particularly during combined use with SSRIs, SNRIs, TCAs, and MAO inhibitors [see Warnings and Precautions ( 5.7 ), Drug Interactions ( 7.4 )]. Medication Overuse Headache Inform patients that use of acute migraine drugs for 10 or more days per month may lead to an exacerbation of headache and encourage patients to record headache frequency and drug use (e.g., by keeping a headache diary) [see Warnings and Precautions ( 5.6 )] . Pregnancy Advise patients to notify their healthcare provider if they become pregnant during treatment or plan to become pregnant [see Use in Specific Populations ( 8.1 )] . Lactation Advise breastfeeding women that they may develop transient breast pain when taking sumatriptan. Advise breastfeeding women that avoiding breastfeeding for 12 hours after treatment with sumatriptan can minimize their infant’s exposure to sumatriptan [see Use in Specific Populations ( 8.2 )] . Ability to Perform Complex Tasks Treatment with Sumatriptan Nasal Spray may cause somnolence and dizziness; instruct patients to evaluate their ability to perform complex tasks after administration of Sumatriptan Nasal Spray. Local Irritation Inform patients that they may experience local irritation of their nose and throat. The symptoms will generally resolve in less than 2 hours. How to Use Sumatriptan Nasal Spray Provide patients instruction on the proper use of Sumatriptan Nasal Spray. Caution patients to avoid spraying the contents of the device in their eyes. Manufactured by: GlaxoSmithKline Durham, NC 27701 Manufactured for: Prasco Laboratories Mason, OH 45040 USA SNS-PS:3PI
Label text from the FDA structured product label by Prasco Laboratories (revised Jan 29, 2026). Long sections are shortened; the complete label is on DailyMed.
Active ingredients
- Sumatriptan Succinate in 66 products
- Sumatriptan in 10 products
Sumatriptan NDC products (76)
| NDC | Strength & form | Labeler | Type |
|---|---|---|---|
| 50090-7957 | Sumatriptan Succinate 6 mg/.5mL Injection, Solution | A-S Medication Solutions | ANDA |
| 50090-7436 | Sumatriptan Succinate 25 mg/1 Tablet, Film Coated | A-S Medication Solutions | ANDA |
| 50090-2497 | Sumatriptan Succinate 6 mg/.5mL Injection | A-S Medication Solutions | ANDA |
| 50090-2144 | Sumatriptan Succinate 25 mg/1 Tablet | A-S Medication Solutions | ANDA |
| 50090-1130 | Sumatriptan Succinate 100 mg/1 Tablet | A-S Medication Solutions | ANDA |
| 50090-1129 | Sumatriptan Succinate 50 mg/1 Tablet | A-S Medication Solutions | ANDA |
| 80425-0475 | Sumatriptan Succinate 50 mg/1 Tablet, Film Coated | Advanced Rx of Tennessee, LLC | ANDA |
| 80425-0224 | Sumatriptan Succinate 100 mg/1 Tablet | Advanced Rx of Tennessee, LLC | ANDA |
| 80425-0258 | Sumatriptan Succinate 100 mg/1 Tablet, Film Coated | Advanced Rx Pharmacy of Tennessee, LLC | ANDA |
| 80425-0318 | Sumatriptan Succinate 50 mg/1 Tablet | Advanced Rx Pharmacy of Tennessee, LLC | ANDA |
| 72485-518 | Sumatriptan Succinate 6 mg/.5mL Injection, Solution | Armas Pharmaceuticals Inc. | ANDA |
| 76420-498 | Sumatriptan Succinate 50 mg/1 Tablet | Asclemed USA, Inc. | ANDA |
| 76420-499 | Sumatriptan Succinate 25 mg/1 Tablet | Asclemed USA, Inc. | ANDA |
| 76420-500 | Sumatriptan Succinate 100 mg/1 Tablet | Asclemed USA, Inc. | ANDA |
| 65862-148 | Sumatriptan Succinate 100 mg/1 Tablet | Aurobindo Pharma Limited | ANDA |
| 65862-147 | Sumatriptan Succinate 50 mg/1 Tablet | Aurobindo Pharma Limited | ANDA |
| 65862-146 | Sumatriptan Succinate 25 mg/1 Tablet | Aurobindo Pharma Limited | ANDA |
| 36000-289 | Sumatriptan Succinate 6 mg/.5mL Injection | Baxter Healthcare Corporation | ANDA |
| 69452-346 | Sumatriptan Succinate 100 mg/1 Tablet, Film Coated | Bionpharma Inc. | ANDA |
| 69452-345 | Sumatriptan Succinate 50 mg/1 Tablet, Film Coated | Bionpharma Inc. | ANDA |
| 69452-344 | Sumatriptan Succinate 25 mg/1 Tablet, Film Coated | Bionpharma Inc. | ANDA |
| 63629-8703 | Sumatriptan 20 mg/1 Spray | Bryant Ranch Prepack | ANDA |
| 63629-8701 | Sumatriptan 5 mg/1 Spray | Bryant Ranch Prepack | ANDA |
| 65145-118 | Sumatriptan Succinate 6 mg/.5mL Injection, Solution | Caplin Steriles Limited | ANDA |
| 69097-644 | Sumatriptan 20 mg/1 Spray | Cipla USA Inc. | ANDA |
| 72189-404 | Sumatriptan Succinate 100 mg/1 Tablet, Film Coated | Direct_Rx | ANDA |
| 55150-173 | Sumatriptan Succinate 6 mg/.5mL Injection, Solution | Eugia US LLC | ANDA |
| 71921-170 | Sumatriptan 20 mg/1 Spray | Florida Pharmaceutical Products, LLC. | ANDA |
| 51407-673 | Sumatriptan Succinate 6 mg/.5mL Injection, Solution | Golden State Medical Supply, Inc. | ANDA |
| 0143-9638 | Sumatriptan Succinate 6 mg/.5mL Injection | Hikma Pharmaceuticals USA Inc. | ANDA |
| 0527-1818 | Sumatriptan 5 mg/.1mL Spray | Lannett Company, Inc. | ANDA |
| 0527-1859 | Sumatriptan 20 mg/.1mL Spray | Lannett Company, Inc. | ANDA |
| 16714-798 | Sumatriptan Succinate 100 mg/1 Tablet | NorthStar Rx LLC | ANDA |
| 16714-796 | Sumatriptan Succinate 25 mg/1 Tablet | NorthStar Rx LLC | ANDA |
| 16714-797 | Sumatriptan Succinate 50 mg/1 Tablet | NorthStar Rx LLC | ANDA |
| 68071-3802 | Sumatriptan Succinate 50 mg/1 Tablet | NuCare Pharmaceuticals, Inc. | ANDA |
| 68071-3755 | Sumatriptan Succinate 100 mg/1 Tablet | NuCare Pharmaceuticals, Inc. | ANDA |
| 68071-5072 | Sumatriptan Succinate 100 mg/1 Tablet | NuCare Pharmaceuticals,Inc. | ANDA |
| 68071-4815 | Sumatriptan Succinate 50 mg/1 Tablet | NuCare Pharmaceuticals,Inc. | ANDA |
| 68071-3350 | Sumatriptan Succinate 50 mg/1 Tablet | NuCare Pharmaceuticals,Inc. | ANDA |
| 68071-3525 | Sumatriptan Succinate 50 mg/1 Tablet, Film Coated | NuCare Pharmaceuticals,Inc. | ANDA |
| 83270-151 | Sumatriptan Succinate 6 mg/.5mL Injection, Solution | ONESOURCE SPECIALTY PHARMA LIMITED | ANDA |
| 83270-152 | Sumatriptan Succinate 6 mg/.5mL Injection, Solution | ONESOURCE SPECIALTY PHARMA LIMITED | ANDA |
| 83270-156 | Sumatriptan Succinate 6 mg/.5mL Injection, Solution | ONESOURCE SPECIALTY PHARMA LIMITED | ANDA |
| 83270-005 | Sumatriptan Succinate 6 mg/.5mL Injection, Solution | ONESOURCE SPECIALTY PHARMA LIMITED | ANDA |
| 45802-598 | Sumatriptan 20 mg/1 Spray | Padagis Israel Pharmaceuticals Ltd | ANDA |
| 45802-619 | Sumatriptan 5 mg/1 Spray | Padagis Israel Pharmaceuticals Ltd | ANDA |
| 68788-6769 | Sumatriptan Succinate 25 mg/1 Tablet | Preferred Pharmaceuticals Inc. | ANDA |
| 68788-8535 | Sumatriptan Succinate 100 mg/1 Tablet, Film Coated | Preferred Pharmaceuticals Inc. | ANDA |
| 68788-8619 | Sumatriptan Succinate 50 mg/1 Tablet, Film Coated | Preferred Pharmaceuticals Inc. | ANDA |
| 68788-6778 | Sumatriptan Succinate 100 mg/1 Tablet | Preferred Pharmaceuticals, Inc. | ANDA |
| 68788-9547 | Sumatriptan Succinate 50 mg/1 Tablet | Preferred Pharmaceuticals, Inc. | ANDA |
| 82804-169 | Sumatriptan Succinate 50 mg/1 Tablet, Film Coated | Proficient Rx LP | ANDA |
| 63187-164 | Sumatriptan Succinate 25 mg/1 Tablet | Proficient Rx LP | ANDA |
| 63187-969 | Sumatriptan Succinate 25 mg/1 Tablet | Proficient Rx LP | ANDA |
| 63187-323 | Sumatriptan Succinate 100 mg/1 Tablet | Proficient Rx LP | ANDA |
| 63187-797 | Sumatriptan Succinate 50 mg/1 Tablet | Proficient Rx LP | ANDA |
| 63187-931 | Sumatriptan Succinate 100 mg/1 Tablet | Proficient Rx LP | ANDA |
| 55700-936 | Sumatriptan Succinate 50 mg/1 Tablet | Quality Care Products, LLC | ANDA |
| 55700-899 | Sumatriptan Succinate 100 mg/1 Tablet | Quality Care Products, LLC | ANDA |
| 70518-1184 | Sumatriptan Succinate 100 mg/1 Tablet | REMEDYREPACK INC. | ANDA |
| 64980-661 | Sumatriptan Succinate 50 mg/1 Tablet, Film Coated | Rising Pharma Holdings, Inc. | ANDA |
| 64980-660 | Sumatriptan Succinate 25 mg/1 Tablet, Film Coated | Rising Pharma Holdings, Inc. | ANDA |
| 64980-662 | Sumatriptan Succinate 100 mg/1 Tablet, Film Coated | Rising Pharma Holdings, Inc. | ANDA |
| 70069-804 | Sumatriptan Succinate 6 mg/.5mL Injection, Solution | Somerset Therapeutics, LLC | ANDA |
| 85766-095 | Sumatriptan Succinate 100 mg/1 Tablet | Sportpharm LLC | ANDA |
| 85766-094 | Sumatriptan Succinate 50 mg/1 Tablet | Sportpharm LLC | ANDA |
| 85766-093 | Sumatriptan Succinate 25 mg/1 Tablet | Sportpharm LLC | ANDA |
| 85766-259 | Sumatriptan Succinate 6 mg/.5mL Injection, Solution | Sportpharm LLC | ANDA |
| 64380-740 | Sumatriptan Succinate 6 mg/.5mL Injection, Solution | Strides Pharma Science Limited | ANDA |
| 63304-099 | Sumatriptan Succinate 100 mg/1 Tablet | SUN PHARMACEUTICAL INDUSTRIES, INC. | ANDA |
| 63304-098 | Sumatriptan Succinate 50 mg/1 Tablet | SUN PHARMACEUTICAL INDUSTRIES, INC. | ANDA |
| 63304-097 | Sumatriptan Succinate 25 mg/1 Tablet | SUN PHARMACEUTICAL INDUSTRIES, INC. | ANDA |
| 70594-068 | Sumatriptan Succinate 6 mg/.5mL Injection | Xellia Pharmaceuticals USA LLC | ANDA |
| 66993-082 | Sumatriptan 20 mg/100uL Spray | Prasco Laboratories | NDA AUTHORIZED GENERIC |
| 66993-081 | Sumatriptan 5 mg/100uL Spray | Prasco Laboratories | NDA AUTHORIZED GENERIC |
Frequently asked questions
What is Sumatriptan used for?
Sumatriptan Nasal Spray is indicated for the acute treatment of migraine with or without aura in adults. Limitations of Use: • Use only if a clear diagnosis of migraine headache has been established. If a patient has no response to the first migraine attack treated with Sumatriptan Nasal Spray, reconsider the diagnosis of migraine before Sumatriptan Nasal Spray is administered to treat any…
What are the side effects of Sumatriptan?
The following adverse reactions are discussed in more detail in other sections of the prescribing information: • Myocardial ischemia, myocardial infarction, and Prinzmetal’s angina [see Warnings and Precautions ( 5.1 )] • Arrhythmias [see Warnings and Precautions ( 5.2 )] • Chest, throat, neck, and/or jaw pain/tightness/pressure [see Warnings and Precautions ( 5.3 )] • Cerebrovascular events [see… See the full label for the complete list.
Who makes Sumatriptan?
Sumatriptan is listed by 34 labelers in the FDA NDC directory, including A-S Medication Solutions, Advanced Rx of Tennessee, LLC, Advanced Rx Pharmacy of Tennessee, LLC, Armas Pharmaceuticals Inc..