Our library of drug research abstracts drawn from the medical literature is updated on a regular schedule, and you can be assured that new sumatriptan research articles will be listed here shortly after becoming available to us.
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Medical research on sumatriptan
Acute migraine therapy: recent evidence from randomized comparative trials.
Curr Opin Neurol. 2008 Jun; 21(3): 331-7
Mett A, Tfelt-Hansen P
(1) A wide array of data regarding acute migraine treatment are available, but few trials strictly adhere to International Headache Society guidelines for patient inclusion criteria.(2) Triptans appear to have similar efficacy profiles, but among newer triptans, almotriptan offers improved tolerability over sumatriptan.(3) Combination indomethacin/caffeine/prochlorperazine most likely has similar therapeutic efficacy to triptan therapy, with further research needed to complete understanding of any potential differences between these treatments.(4) Multi-targeted combination therapy with a triptan plus a non-steroidal anti-inflammatory (NSAID), such as sumatriptan/naproxen sodium, is more effective in acute migraine treatment than monotherapy with either agent alone.(5) It is unclear whether triptans offer clinically relevant benefits over aspirin or NSAIDs in migraine patients. Thus NSAIDs, particularly effervescent aspirin, should be considered the first-line treatment of migraine attacks.
Arch Pharm (Weinheim). 2008 Apr 28;
Rodrigues T, Moreira R, Guedes RC, Iley J, Lopes F
Sumatriptan is a potent and selective 5-HT(1B) and 5-HT(1D )agonist used in the symptomatic treatment of migraine; it shows poor oral bioavailability ascribed, in part, to its low lipophilicity. In an attempt to develop acyloxymethyl prodrugs of sumatriptan suitable for oral administration, we carried out the reaction of sumatriptan with chloromethyl esters. To our surprise, acyloxymethylation occurred preferentially at the indole nitrogen rather than at sulfonamide nitrogen, reflecting a difference either in product stability or in the nucleophilicities of the indole and sulfonamide anions. The hydrolysis of the corresponding N(1)-acyloxymethyl derivatives was studied in aqueous buffers and in human plasma, by HPLC. N(1)-Acyloxymethyl derivatives of sumatriptan are rapidly hydrolysed to the chemically stable N(1)-hydroxymethylsumatriptan at pH 1-13. Slow formation of the parent drug was observed only at high pH values. Hydrolysis of sumatriptan derivatives is slower in human plasma than in phosphate buffer and also generates N(1)-hydroxymethylsumatriptan rather than the parent drug. These results indicate that N(1)-acyloxymethyl derivatives of sumatriptan cannot be considered as true prodrugs of sumatriptan.
Acute treatment and prevention of menstrually related migraine headache: evidence-based review.
Neurology. 2008 Apr 22; 70(17): 1555-63
Pringsheim T, Davenport WJ, Dodick D
Menstrually related migraine (MRM) headache is common in women and associated with substantial disability. Compared to nonmenstrual migraine, MRM attacks are more severe, longer in duration, and have a poorer response to analgesics. The purpose of this guideline is to provide a systematic review and meta-analysis of the existing therapy trials for MRM and evidence-based recommendations for acute and short-term preventive treatment of MRM headache. Prospective, double-blind, randomized controlled trials of any pharmacologic agent for the symptomatic relief or prevention of MRM headache were included in the guideline. The main outcomes considered were the pain response and pain-free response at 2 hours for acute treatment trials, and the incidence of MRM or the number of days on which MRM attacks occurred for short-term prevention trials. Nineteen trials were included in the analysis. The US Preventive Services Task Force quality criteria were used to assess trial quality and to grade recommendations. Based on the evidence, grade B recommendations can be made for the use of sumatriptan 50 and 100 mg, mefenamic acid 500 mg, and rizatriptan 10 mg for the acute treatment of MRM. For the preventive treatment of MRM, there are grade B recommendations for the perimenstrual use of transcutaneous estrogen 1.5 mg, frovatriptan 2.5 mg twice daily, and naratriptan 1 mg twice daily. Choosing among treatment strategies must be based on clinical considerations.
[Efficacy of sumamigren at early and late stages of migraine attack.]
Zh Nevrol Psikhiatr Im S S Korsakova. 2007; 107(8): 29-33
Tabeeva GR, Azimova IE
Three migraine attacks have been studied in 30 patients aged 39,4+/-10,5 years. A significant decrease of headache and concomitant symptoms was found 1, 2 and 6 h after receiving of sumamigren (sumatriptan). The drug was effective in 2 out of 3 attacks in most of the patients (53,3%); in 3 attacks - in 26,7%; in 1 attack - in 6,7%. In 13,3% of the patients the drug did not exert a therapeutic effect. When administering at the early stage of the attack, the drug reduced the headache after 1 and 2 h more significantly comparing to patients receiving it at the later stage. In case of early prescription of sumamigren, the relapse of headache was observed in 7,8% and in later one - in 20,5% of patients. During the first 24 h of attack, patients switched to the drug at the early stage reported higher quality of life (mean score 45,1+/-14,6) than those with later prescription (71,4+/-18,3). It has been concluded that sumamigren is an effective medication for stopping the migraine attack, in particular at its the beginning.
Triptans: actions and reactions.
Headache. 2008 Apr; 48(4): 611-3
Nahas SJ, Silberstein SD
Subcutaneous sumatriptan is superior to placebo in achieving headache relief. Some commonly reported adverse events are paresthesias, tingling, and transient worsening of headache. Why do patients develop these symptoms? Our unique case may shed light on its actions.
[Cerebrovascular serotonin antagonists and agonist among tropan derivatives]
Eksp Klin Farmakol. 2008 Jan-Feb; 71(1): 26-30
Gan'shina TS, Bezhanian SG, Kostochka LM, Volkova MIu, Mirsoian RS
A series of new tropan derivatives have been synthesized and investigated, which can both weaken and potentiate the serotonin-induced cerebrovascular constrictory reactions. The compound LK-728 produces a pronounced antiserotonin cerebrovascular action comparable to that of tropoxin, but being superior to the reference drug in the effect duration. On the contrary, another tropan derivative LK-769 enhances the cerebrovascular response to serotonin. A similar effect was demonstrated with the well-known antimigraine agent sumatriptan, which is an agonist of 5HT1B/1D receptors. The ability of sumatriptan to increase the local cerebral blood flow which was observed in our experiments, may also play an important role in the mechanism of the antimigraine action produced by this serotonin receptor agonist.
Use of 5-HT1 agonists in pregnancy.
Ann Pharmacother. 2008 Apr; 42(4): 543-9
Evans EW, Lorber KC
OBJECTIVE: To report and evaluate available data on the use of serotonin 5-HT(1) agonists (triptans) during pregnancy. DATA SOURCES: A PubMed search, limited to English-language articles on human subjects, was conducted (1990-December 2007) using the search terms pregnancy, migraine, and the individual triptan drug names. In addition, the manufacturers of all 7 available triptans were contacted regarding the existence of a pregnancy registry for their drug(s) and the availability of registry reports. STUDY SELECTION AND DATA EXTRACTION: All retrospective and prospective studies reporting on pregnancy outcomes after the use of a triptan were included and critically evaluated. Data from all available manufacturer-sponsored pregnancy registries were also included. DATA SYNTHESIS: Safe and effective treatment of migraine during pregnancy is imperative. Data involving sumatriptan and, to a lesser extent, naratriptan and rizatriptan, exist primarily regarding exposure in the first trimester. These data show no significant differences in congenital malformations or poor pregnancy outcomes when compared with expected rates in the general population or with the observed rates in control subjects. There is very little information regarding exposure in middle and late pregnancy. CONCLUSIONS: Sumatriptan appears to be a safe treatment alternative for pregnant women who experience new-onset or worsened migraines in the first trimester. Further observation is needed prior to recommending its use in later trimesters. Based upon available data, the other agents in this class cannot be recommended for use during pregnancy at this time.
Update on the therapy of the trigeminal autonomic cephalalgias.
Curr Treat Options Neurol. 2008 Jan; 10(1): 30-5
Lenaerts ME
The treatment of trigeminal autonomic cephalalgias requires very careful attention to clinical aspects. It is important to spend enough time assessing the patient to arrive at an accurate diagnosis. Identifying trigger factors (eg, alcohol), when applicable, is part of the therapy, as behavior modifications may be necessary. Cluster headache treatment should never be delayed; patients should be able to visit the clinic within 48 hours to expedite medication initiation. Abortive therapy typically is best achieved with nasal oxygen, sumatriptan injections, or both. Typically, a steroid taper is begun and will be continued for a few days. A prophylactic agent such as verapamil or topiramate also is initiated immediately and will be taken for a period slightly beyond the expected duration of the last cluster period before an attempt is made to taper it off. For chronic cluster headache, lithium carbonate is recommended after a few weeks if these other treatments have failed. If more than three regimens of medical therapy fail, patients should be considered for neurostimulation procedures. Paroxysmal hemicrania most often responds to indomethacin. Failure may be due to a dosage that is too low. Gastric protection should always be given, because this medication has a high rate of gastric complications. Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) remain very difficult to treat. Lamotrigine is the first recommendation. Overall, one of the most crucial aspects of the management of patients with these disabling headache syndromes is patient education regarding what their disorder is and the reasoning behind the therapeutic options offered.
[Diagnostic and therapeutic alogarithm in functional dyspepsia]
Acta Gastroenterol Latinoam. 2007 Sep; 37 Suppl 1: S25-8
Iantorno G, Corti R, Fernández LM, Soifer L, Bilder C, Soifer G, De Los Santos AR, Gianoni C, Bernstein S, Secilio O
INTRODUCTION: Dyspepsia is a word that means bad digestion. In the conviction of which it is a question of an entity that it includes different disciplines, we realize a meeting consensus to discuss and to resolve a diagnostic and therapeutic algorithm of national order. OBJECTIVE: To agree on a national algorithm applicable to the functional dyspepsia. MATERIAL AND METHODS: In June 2005 a multidisciplinary group met to design and to propose a diagnostic and therapeutic algorithm for the functional dyspepsia. RESULTS: Priority gives to the medical-patient relationship and to the reinsurance. Then we divide the patients if they have signs of alarm. If they are present we studied them, if not we divide them, in accordance to the principal symptoms, in pain or epigastric discomfort. If they have pain we realized an endoscopy and a abdominal ultrasound scan. If they are positive, treatment of the disease. If the studies are negative or it has epigastric discomfort we propose a therapeutic test. Pain: H2 bloquers, wait 4 to 6 weeks, if it not response we propose a PPI, wait for 4 to 6 weeks, if there is no response psychiatric or psychological consultation. Discomfort: proquinetics, wait for 4 to 6 weeks if there are no answers, antidepressants in low doses, wait for 4 to 6 weeks if there are no answers, ca. bloquers, sumatriptan or trimebutina. In all cases we can add tranquillizers in anxious personality. CONCLUSIONS: A multidisciplinary dignostic and therapeutic consensus of national order for the patients with functional dyspepsia was obtained.
Sumatriptan normalizes the migraine attack-related increase in brain serotonin synthesis.
Neurology. 2008 Feb 5; 70(6): 431-9
Sakai Y, Dobson C, Diksic M, Aubé M, Hamel E
BACKGROUND: Altered serotonin (5-HT) neurotransmission has been implicated in the pathophysiology of migraine headache. OBJECTIVES: To test this hypothesis in migraine patients in vivo using PET and alpha-[(11)C]methyl-l-tryptophan as a surrogate marker of brain 5-HT synthetic rate during different phases of their migraine attack and after acute antimigraine therapy with sumatriptan, and to compare them with normal controls. METHODS: Six patients were scanned 1) within 6 hours after the onset of a spontaneous migraine attack, 2) 2 hours after subcutaneous sumatriptan, and 3) interictally when migraine free for at least 3 days. Head pain was rated before each scan, and before and every 15 minutes after sumatriptan. RESULTS: Brain 5-HT synthesis was highest during attacks, lowest after sumatriptan, and intermediate when patients were migraine free. All states were statistically different from the others in virtually all brain regions examined. 5-HT synthetic rates in patients during migraine attacks did not differ from those of age- and sex-matched controls, whereas they were significantly lower after sumatriptan in a majority of regions. Interictally, global brain 5-HT synthetic rate was slightly, albeit not significantly, lower (-14%) in migraine patients than in controls, with specific cortical areas exhibiting proportionally more severe reductions (-28% to 31%). CONCLUSIONS: These findings point to a low cortical serotonergic tone in migraine patients interictally. Further, they demonstrate widespread increases in brain serotonin (5-HT) synthetic rate in migraine patients during attacks, and that triptans exert a negative feedback regulation of brain 5-HT synthesis concurrently with modulation of pain pathways.