Onzetra
Onzetra (sumatriptan) is a triptan that's used to treat migraine attacks with or without aura in adults. Onzetra (sumatriptan) is a device with a mouthpiece. It comes with separate nosepieces containing the medication that you attach to the device. You use the mouthpiece and nosepiece together to inhale the medication through your nose by using the power of your breath. Onzetra (sumatriptan) is available by prescription only and is a brand-name medication. Common side effects are changes in taste and discomfort in the nose.
What is Onzetra (sumatriptan)?
What is Onzetra (sumatriptan) used for?
Short-term treatment of migraines with or without aura in adults
How Onzetra (sumatriptan) works
Onzetra (sumatriptan) is a triptan. It relieves migraines by attaching to serotonin receptors in your brain. Serotonin is a natural chemical in your body that's thought to play a role in causing migraines.
When Onzetra (sumatriptan) attaches to the serotonin receptors in the brain, the medication tightens the blood vessels there and lessens blood vessel swelling that can cause migraine pain. The medication also helps stop the release of proteins that cause inflammation and that are involved in causing migraine pain.
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What are the side effects of Onzetra (sumatriptan)?
Common Side Effects
- Unusual taste in the mouth (20%)
- Nasal discomfort (11%)
- Runny nose (5%)
Other Side Effects
- Stuffy nose
- Nosebleeds
Serious Side Effects
- Heart attack or other heart problem: dizziness, chest pain or tightness, cold sweat, nausea, trouble breathing, irregular heartbeat
- Stroke or brain injury: sudden weakness on one side of your body, severe headache, changes in your speech or vision, changes in balance, trouble with movement, confusion
- Dangerously high blood pressure: anxiety, blurry vision, chest pain, confusion, severe headache, nausea, vomiting
- Blood vessel spasms: bloody diarrhea, severe stomach pain, loss of vision, tightness or numbness of legs or feet
- Serotonin syndrome: fast heart rate, dizziness, sweating, flushing, tremor (shakiness), muscle stiffness or twitching, uncoordinated movement, hallucinations
- Allergic reaction: rash or hives, swelling of face or throat, trouble breathing
- Seizure
Source: DailyMed
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The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Burning, pain, tingling, or color changes in the legs or feet
- Heart attack—pain or tightness in the chest, shoulders, arms, or jaw, nausea, shortness of breath, cold or clammy skin, feeling faint or lightheaded
- Heart rhythm changes—fast or irregular heartbeat, dizziness, feeling faint or lightheaded, chest pain, trouble breathing
- Increase in blood pressure
- Raynaud's—cool, numb, or painful fingers or toes that may change color from pale, to blue, to red
- Seizures
- Serotonin syndrome—irritability, confusion, fast or irregular heartbeat, muscle stiffness, twitching muscles, sweating, high fever, seizure, chills, vomiting, diarrhea
- Stroke—sudden numbness or weakness of the face, arm, or leg, trouble speaking, confusion, trouble walking, loss of balance or coordination, dizziness, severe headache, change in vision
- Sudden or severe stomach pain, nausea, vomiting, fever, or bloody diarrhea
- Vision loss
Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):
- Change in taste
- Dizziness
- General discomfort or fatigue
- Irritation inside the nose or throat
- Runny or stuffy nose
Pros and cons of Onzetra (sumatriptan)
Pros
Can start to relieve migraine pain within 30 minutes
A first-choice option for short-term treatment of migraines in adults
A good option for people who have trouble swallowing pills and who don't want to use an injection
Cons
Can cause nose or throat irritation and an unusual taste in your mouth after use
Need to use 1 nosepiece in each nostril to get the full dose
Only available as a brand-name product in one strength
Pharmacist tips for Onzetra (sumatriptan)
Take Onzetra (sumatriptan) at the first sign of a migraine attack. This medication isn't meant to be used regularly to prevent migraines. Speak with your prescriber about treatment options to prevent migraines if you have migraines often.
If your migraine comes back or if it doesn't completely go away after at least 2 hours since you've taken Onzetra (sumatriptan), you can take a second dose of medication. Make sure to wait at least 2 hours between doses because taking it any sooner can cause more side effects, like sleepiness and dizziness.
You might feel some tightness, pressure, or pain in the chest, throat, jaw, or neck area after you take Onzetra (sumatriptan). This feeling usually doesn't last long and will go away. Keep in mind that these symptoms are very similar to those of a heart attack or other heart problems. Get medical help right away if this sensation worsens or if it doesn't go away.
Triptans like Onzetra (sumatriptan) can make you sleepy, dizzy, or weak. Don't drive or do anything that you need to pay attention to until you know how this medication affects you.
It's best to avoid alcohol while you're taking Onzetra (sumatriptan). Alcohol can worsen side effects like feeling sleepy and dizzy. Alcohol can also raise your likelihood of having another migraine.
Don't take Onzetra (sumatriptan) or any other migraine medication for more than 9 days in a month. Otherwise, your headaches can get worse and happen more often. Speak with your prescriber about how to best manage your migraines.
Make sure to let your care team know about all the medications (including vitamins and supplements) that you're taking or planning to take. Onzetra (sumatriptan) interacts with a lot of medications. So it's important for your care team to check for harmful drug interactions and make changes to your treatment plan, if needed, to keep you safe.
How to use Onzetra (sumatriptan):
Carefully read and follow the instructions for how to use Onzetra (sumatriptan). Ask your care team if you have any questions.
Each foil pouch contains 2 nosepieces. Use both nosepieces right after you open the pouch. And use 1 nosepiece for each nostril for a full dose of Onzetra (sumatriptan). After you use the first nosepiece in one nostril, remember to use the second nosepiece in your other nostril.
Insert the nosepiece into the device; you should hear it click into place. Press the white button all the way down and then release it. This makes a hole in the capsule containing the medication that's inside the nosepiece. This hole allows the medication to come out.
Place the nosepiece deep into your nostril. Then, rotate the device so that you can place the mouthpiece into your mouth. Blow hard into the mouthpiece for 2 to 3 seconds like you're blowing up a balloon. You might hear a rattling sound or feel something vibrating in the device. The power of your breath helps get the medication into your nostril. Be sure you don't press the white button while you're blowing into the mouthpiece.
Remove the nosepiece from the device by pressing the clear tab, and check the capsule inside to make sure all the medication is gone. It's normal to have a thin, white residue left in the capsule after you use the nosepiece. If the capsule is still full of medication and looks like it hasn't been used, reinsert the nosepiece into the device and repeat the steps to take the medication inside the nosepiece.
You can only use each nosepiece once. Throw the nosepieces away in the trash after you've used them.
You can clean the Onzetra (sumatriptan) device by wiping the mouthpiece with a clean, dry, lint-free cloth between uses. Don't wash the device with water and don't get it near any liquids because it needs to stay dry.
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Frequently asked questions about Onzetra (sumatriptan)
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What are the risks and warnings for Onzetra (sumatriptan)?
Onzetra (sumatriptan) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Heart problems and high blood pressure
Risk factors: History of heart problems | Family history of heart disease | Age older than 65 | Diabetes | High blood pressure | People who are considered obese | Smoking tobacco
Although rare, some people have reported serious heart problems, such as heart attack and heart rhythm problems, within a few hours after they took Onzetra (sumatriptan). In addition, this medication can raise your blood pressure, rarely to dangerously high levels.
If you have a history of heart problems or blood circulation problems, speak with your prescriber first to make sure Onzetra (sumatriptan) is as safe for you as possible. Make sure to periodically check your blood pressure while you're taking Onzetra (sumatriptan), and let your prescriber know if it's higher than usual. Get emergency help right away if you experience a heart attack, severe headache, chest pain, or irregular heartbeat.
Stroke or other brain injury
Some people who've taken triptans like Onzetra (sumatriptan) have experienced life-threatening strokes or bleeding in the brain. For this reason, you won't be able to take Onzetra (sumatriptan) if you've had a stroke before. Let your care team know about your medical history.
Symptoms of stroke or other brain injuries include sudden weakness on one side of the body, severe headaches, drooping face, trouble breathing, or changes in your speech or vision. These symptoms can be similar to migraine symptoms, so strokes can be mistaken for a migraine. To lower the risk of making this mistake, it's important that you're properly diagnosed with migraines before you start Onzetra (sumatriptan). Stop taking this medication and get medical help as soon as possible if you notice symptoms of a stroke, especially if you haven't had a migraine before.
Blood vessel spasms
Onzetra (sumatriptan) can cause blood vessel spasms, or narrowing of the blood vessels, in certain parts of your body. Depending on the location, these spasms can lead to stomach problems (e.g., stomach pain, bloody diarrhea), vision problems, and changes in sensation in your hands and feet. Sometimes, it can lead to color changes in your hands and feet (can turn pale or more reddish or bluish depending on how much blood is flowing through). Don't take any more Onzetra (sumatriptan) until you see a healthcare provider if you notice these symptoms after you take the medication. Your care team can check out what's going on.
Serotonin syndrome
Risk factors: Taking other medications that raise serotonin levels in your brain
Some people who take Onzetra (sumatriptan) have developed a rare, but potentially life-threatening condition called serotonin syndrome. This condition happens when there's too much serotonin in the brain. Your risk for serotonin syndrome goes up if you take Onzetra (sumatriptan) with other medications that can raise your serotonin levels, such as certain antidepressants, mental health medications, pain medications, and other triptans.
Let your care team know about all the medications you take before you start Onzetra (sumatriptan), as well as any medications you plan to take. Get medical help right away if you have any symptoms of serotonin syndrome, such as fast heart rate, sweating, muscle stiffness or spasms, fever, and confusion.
Allergic reactions
Allergic reactions to medications containing sumatriptan, like Onzetra (sumatriptan), are possible. These reactions can include life-threatening reactions like facial swelling, shock, and anaphylaxis (closing of the throat). Get medical attention as soon as possible if you notice dizziness, difficulty breathing, a choking sensation, nausea, swelling around your eyes, or swelling of the lips or tongue after you take Onzetra (sumatriptan).
Seizures
Risk factors: History of seizures or epilepsy
Some people have had seizures after they took Onzetra (sumatriptan). This has happened in people who have a history of seizures but can also happen in people who've never had one before. Get medical help right away if you have a seizure while you're taking Onzetra (sumatriptan).
Nose or throat irritation
Onzetra (sumatriptan) might cause irritation in the nose and throat. This can include a burning, numbing, or tingling sensation; runny nose; pain; or soreness. These symptoms are usually temporary and they generally go away in less than 2 hours. Let your prescriber know if these side effects continue to bother you.
Onzetra (sumatriptan) dosage forms
| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 16 nosepieces of 11mg | 1 carton | $932.36 | $932.36 |
Typical dosing for Onzetra (sumatriptan)
Each Onzetra (sumatriptan) nosepiece contains 11 mg of sumatriptan.
The typical dose is 2 nosepieces (1 nosepiece for each nostril) inhaled through the nose at the first sign of a migraine.
If the migraine comes back or if it doesn't completely go away, you can take another dose at least 2 hours after the first dose.
If the only sumatriptan medication you're taking is Onzetra (sumatriptan): The maximum dose of Onzetra (sumatriptan) is 4 nosepieces within a 24-hour period.
If you're taking Onzetra (sumatriptan) and another sumatriptan medication (e.g., sumatriptan tablets (Imitrex),sumatriptan autoinjector (Imitrex Statdose)): Don't take more than 1 dose of Onzetra (sumatriptan) and 1 dose of your other sumatriptan medication within a 24-hour period. Make sure to take your sumatriptan doses at least 2 hours apart, if needed.
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Onzetra (sumatriptan) contraindications
Coronary artery disease, including history of heart attack
Certain conditions that cause an irregular heart rhythm (arrhythmias)
History of stroke or transient ischemic attack ("mini-stroke")
History of hemiplegic or basilar migraines (because of higher risk of stroke)
Uncontrolled high blood pressure
Use of ergot-containing or ergot-type medications like dihydroergotamine (Migranal) or other triptans in the last 24 hours
Currently take or have taken a monoamine oxidase inhibitor (MAOI), such as selegiline, in the last 14 days
Severe liver problems (e.g., cirrhosis)
Allergy to sumatriptan
What are alternatives to Onzetra (sumatriptan)?
Short-term treatment of migraines with or without aura in adults
Treatment of migraine attacks with or without aura in people ages 6 years and older
What is the latest news about Onzetra (sumatriptan)?
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References
Best studies we foundAilani, J., et al. (2021). The American Headache Society consensus statement: Update on integrating new migraine treatments into clinical practice. Headache.
Currax Pharmaceuticals LLC. (2022). How to use Onzetra® Xsail®.
Currax Pharmaceuticals LLC. (2024). Onzetra Xsail- sumatriptan succinate capsule [package insert]. DailyMed.
Feuerstadt, P. (2019). Small bowel ischemia overview. American College of Gastroenterology.
Kumar, A., et al. (2023). Hemiplegic migraine. StatPearls.
Tepper, S. J., et al. (2018). Breath-powered sumatriptan dry nasal powder: An intranasal medication delivery system for acute treatment of migraine. Medical Devices.
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