Sumatriptan nasal spray is indicated for the acute treatment of migraine with or without aura in adults.

5-HT Agonists

Sumatriptan binds with high affinity to human cloned 5-HT_1B/1D receptors. Sumatriptan presumably exerts its therapeutic effects in the treatment of migraine and cluster headaches 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.

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. 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.

• 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.
• 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
• 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.
• 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

• History of coronary artery disease or coronary artery vasospasm
• Wolff-Parkinson-White syndrome or other cardiac accessory conduction pathway disorders
• History of stroke, transient ischemic attack, or hemiplegic or basilar migraine
• Peripheral vascular disease
• Ischemic bowel disease
• Uncontrolled hypertension
• Recent (within 24 hours) use of another 5-HT 1 agonist (e.g., another triptan) or of an ergotamine-containing medication.
• Concurrent or recent (past 2 weeks) use of monoamine oxidase-A inhibitor.
• Hypersensitivity to Sumatriptan (angioedema and anaphylaxis seen)
• Severe hepatic impairment

Most common adverse reactions were burning sensation, disorder/discomfort of nasal cavity/sinuses, throat discomfort, nausea and/or vomiting, bad/unusual taste, and dizziness/vertigo.

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. 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.

• Myocardial ischemia/infarction and Prinzmetal’s angina: Perform cardiac evaluation in patients with multiple cardiovascular risk factors.
• Arrhythmias: Discontinue sumatriptan if occurs.
• 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.
• Cerebral hemorrhage, subarachnoid hemorrhage, and stroke: Discontinue sumatriptan if occurs.
• Gastrointestinal ischemic reactions and peripheral vasospastic reactions: Discontinue sumatriptan if occurs.
• Medication overuse headache: Detoxification may be necessary.
• Serotonin syndrome: Discontinue sumatriptan if occurs.
• Seizures: Use with caution in patients with epilepsy or a lowered seizure threshold.

Store between 2°C and 30°C. Protect from light.