Sumatriptan appears safe in pregnancy
Acetaminophen is what most obstetricians recommend pregnant women take for their headaches. However, it is not very effective for migraine headaches and it is not as safe as we thought (see my recent post). Fioricet is another drug favored by some obstetrician and it is also not very effective and not very safe.
Sumatriptan (Imitrex) was introduced 20 years ago and the manufacturer has maintained a registry of women who took the drug while pregnant. The final results of this registry were just published in the journal Headache. The registry included 626 women who were exposed to sumatriptan during their pregnancies. They also followed women who took two other migraine drugs, naratriptan (Amerge) and a combination of sumatriptan with naproxen (Treximet). However, there were too few women in those groups to make any conclusions about the drugs’ safety.
As far as sumatriptan, the risk of major birth defects was not increased. The authors also reviewed several other large studies which assessed the risk of taking migraine medications during pregnancy. One of the studies were from the Swedish Medical Birth Register, which included 2257 births following first trimester sumatriptan exposure. No risk was found in this study either.
In summary, pregnant women suffering from severe migraines should be prescribed sumatriptan. Most women respond to an oral form (tablet), but those with very severe attacks should be offered an injection.
Unfortunately, there are no studies of specific doses, but the most common dose used in general is 100 mg. The study did not look at each trimester separately either. What we do know is that sumatriptan is not more dangerous than other drugs used to treat migraine headaches. However, none of these drugs belong to category B, which includes drugs known to be safe in pregnancy. They belong to category C, which means that they are probably safe, but not enough information is available to state that they are safe.
This article is very helpful, however did the study suggest at what dose was safe? Is 100mg safe as an oral form (tablet) during pregnany. Did the study state if the medication was safe to use in all three trimesters of pregnany, to be used as needed when the risk is outweight by the benefits?