Handbook of clinical drug data.pdf - Me and My Life

8 ANALGESIC AND ANTI-INFLAMMATORY DRUGSby glucuronidation and renal elimination. About 40% is found in the feces and60% is excreted renally, 22% unchanged, and 40% as the active indole acetic acidmetabolite. 17-19t ¹⁄₂. 1.9 ± 0.3 hr. 19Adverse Reactions. Frequent side effects are pain and redness at SC injectionsite, tingling, hot flushes, dizziness, and chest tightness or heaviness. With thenasal spray, throat discomfort and unusual taste occur frequently. With all routesof administration, occasional weakness, myalgia, burning sensation, tightness inchest, transient hypertension, drowsiness, headache, numbness, neck pain, abdominaldiscomfort, mouth/jaw discomfort, and sweating occur. Rarely, cardiac arrhythmias,myocardial ischemia, polydipsia, dehydration, dyspnea, skin rashes,dysuria, and dysmenorrhea occur. The drug can accumulate in melanin-rich tissuessuch as the eye with long-term use. Several cases of ischemic colitis havebeen reported after sumatriptan use.Contraindications. IV administration; ischemic heart disease; Prinzmetal’sangina; uncontrolled hypertension; concurrent administration of MAO inhibitorsor within 2 weeks of discontinuation; within 24 hr of an ergotamine-containingdrug or ergot derivative such as methysergide or dihydroergotamine; hemiplegicor basilar migraine.Precautions. Pregnancy. Use with caution in those with impaired hepatic function,seizure disorder, neurologic lesion, or cardiovascular disease; postmenopausalwomen; or men >40 yr.Drug Interactions. Nonselective MAO inhibitors or MAO-A inhibitors can increasethe systemic availability of sumatriptan (especially after oral administration).Theoretically, ergot alkaloids and sumatriptan can cause prolonged vasospasticreactions if used together. (See Contraindications.) SSRIs can causeweakness, hyperreflexia, and incoordination when given with sumatriptan andother triptans.Parameters to Monitor. Renal, hepatic, and cardiovascular status initially and q 6months.Notes. Subcutaneous sumatriptan is much more expensive than alternatives. It iseffective in the treatment of cluster headache and appears to be more effectivethan ergotamine/caffeine in aborting migraine. 20 (See Selective Serotonin AgonistsComparison Chart.)