Injectable sumatriptan: Imitrex, Sumavel, Alsuma
Injections of sumatriptan (Imitrex) are very underutilized. Many doctors fail to offer this option to their migraine and cluster headache sufferers because they are not aware of this option or more often because they are not aware how debilitating migraines can be or because they consider it to be dangerous. Patients who wake up with a severe headache (migraines commonly occur in the morning) and have to go to work or take care of their children often become disabled for the day because oral medications are not effective. Another group of patients who benefit from injections are those with nausea and vomiting. But you do not have to have a severe attack or have vomiting to take an injection. I have occasional migraines, usually triggered by wine or lack of sleep and if I take an oral medication it will usually help, but it may take an hour or even two before it works. So, if I have a headache late in the evening, I take an injection which stops my migraine within 10 minutes and I can fall asleep right away instead of waiting for an hour before the tablet takes effect. Sumatriptan injection is the only drug approved for the treatment of cluster headaches and it is a true life saver for cluster sufferers.
It is very easy to give yourself an injection of sumatriptan. There are three different devices on the market. The oldest one is a little more cumbersome to use, which can be a factor when you are in the midst of a severe attack, but it costs the least and is more likely to be covered by the insurance. Another injector, Sumavel does not have a needle – the device shoots the medicine into the skin through a tiny hole. This device is easier to use but some people complain that it is more painful despite it being needleless. The third device, Alsuma is identical to the one used in the Epi-Pen and it is also very easy to use. Sumatriptan is also available in vials. Some people prefer to use vials for several reasons. First, they are cheaper, second, they may be less painful to inject since you can use a syringe with a smaller needle than the ones in autoinjectors and third, some people get excellent results and fewer side effects with a smaller dose and the vial allows them to use 2 or 3 mg. Being able to use 2 or 3 mg at a time is particularly useful for cluster headache patients who have one or two headaches a day for extended periods of time and don’t get enough injections from their insurer.
If you suffer from severe migraine or cluster headaches ask your doctor about injections of sumatriptan. The main contraindication is heart disease or multiple risk factors for heart disease, but otherwise it is a very safe medicine. In Europe tablets of sumatriptan are sold without doctor’s prescription.
Great post! I’ve worked as a technician in a pharmacy for 3 years, approx 3000 scripts a month, and I only came across Sumavel for the first time today. The patient exclaimed it really helps her, but since she only wants to use it on her thighs, she’s got them all bruised up now. It may certainly be underutilized, these drugs.
Yes, sumatriptan injection is often more effective than a tablet. If you haven’t done it yet, you may also want to try other triptan tablets – rizatriptan (Maxalt), zolmitriptan (Zomig), naratriptan (Amerge) and other.
I have been suffering from migraines for the ast 4 years. the sumatriptan pills did not help me at all. Do you think this would still be an option for me even though the pills didnt work?
Metoclopramide (Reglan) is an effective anti-nausea drug, which is often used to treat nausea of migraine and it does seem to have some effect on the pain as well. However most people do not obtain sufficient relief from it, although I’ve seen a handful of patients for whom it relieved both nausea and pain.
Have you ever used or considered metoclopramide IM to abort migraines in people who do not respond to triptans? Or for refractory migraines. I realize there is the risk of EPS side effects, but it’s used IV in the ER, but doesn’t seem to work orally.
Yes, the oldest, generic product is also called STATdose. I haven’t seen any prefilled syringes. Perhaps what you saw is the autoinjector cartridges which are sometimes called “prefilled syringe cartridges”
I’ve just begun looking at sumatriptan injection options, so your comments were very helpful. When you said, “The oldest one is a little more cumbersome to use, which can be a factor when you are in the midst of a severe attack, but it costs the least and is more likely to be covered by the insurance.” were you referring to STATdose, the autoinjector?
I’ve also found that one manufacturer makes sumatriptan in a prefilled syringe, which I thought would be the cheapest option on the market, but I’ll need to look at insurance coverage.