Sutrip Special Precautions

Sumatriptan and other serotonin (5-HT1) agonists should only be used where there is a clear diagnosis of migraine or cluster headache and care should be taken to exclude other potentially serious neurological conditions. They should not be used for prophylaxis and should not be given to patients with basilar, hemiplegic, or ophthalmoplegic migraine. Serotonin (5-HT1) agonists are contraindicated in patients with uncontrolled hypertension, ischaemic heart disease (coronary artery disease), a history of myocardial infarction, coronary vasospasm (Prinzmetal's angina), peripheral vascular disease, or a previous cerebrovascular accident or transient ischaemic attack. Unrecognised cardiovascular disease should be excluded before the use of serotonin (5-HT1) agonists in postmenopausal women, men over 40 years of age, and those with risk factors for ischaemic heart disease. If chest pain and tightness occur during use, appropriate investigations should be performed. Sumatriptan should not be used intravenously because of the increased risk of producing coronary vasospasm. Drowsiness may occur after treatment with serotonin (5-HT1) agonists and patients thus affected should not drive or operate machinery. Sumatriptan should be used with caution in patients with hepatic or renal impairment and should generally be avoided if impairment is severe. There have been rare reports of seizures after use of sumatriptan and it should therefore be used with caution in patients with a history of epilepsy or other conditions predisposing to seizures. Patients with hypersensitivity to sulfonamides may exhibit a similar reaction to sumatriptan.
Use in Lactation: Infant exposure can be minimised by avoiding breastfeeding for 12 hours after treatment. The distribution of sumatriptan into breast milk after a 6-mg subcutaneous dose has been studied in 5 lactating mothers. The mean total recovery of sumatriptan in breast milk was estimated to be 14.4 micrograms or 0.24% of the dose. It was calculated that on a weight-adjusted basis an infant could receive a maximum of 3.5% of the maternal dose.
Use in Pregnancy: Pregnancy. Sumatriptan crosses the placenta; however, only a very small quantity reaches the fetus. A literature review concluded that exposure to sumatriptan in pregnancy posed no additional risk of birth defects compared with that in the general population, but as for other drugs sumatriptan should only be used in pregnancy when the benefit justifies the potential risk to the fetus.