sumatriptan
Sumatriptan nasal spray, also known by its brand names Tosymra and Imitrex, is a triptan medication for adults. It can treat migraine attacks with or without aura. Typically, you spray this medication into the nose at the start of a migraine attack. Sometimes, you might need to give yourself another dose. But using sumatriptan nasal spray more often than recommended can worsen headaches. Some common side effects of sumatriptan nasal spray include burning in the nose, throat irritation, and changes in taste.
What is Sumatriptan nasal spray?
What is Sumatriptan nasal spray used for?
How Sumatriptan nasal spray works
Sumatriptan nasal spray is a triptan. It works by attaching to and turning on serotonin receptors in the blood vessels and nerves in your brain. This causes the blood vessels to tighten as well as lower the release of proteins that cause inflammation and pain. This is thought to help relieve migraines.
Drug facts
Side effects of Sumatriptan nasal spray
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Bad or unusual taste (14-25%)
- Nausea or vomiting (11-14%)
- Nose irritation (3-4%)
Less Common Side Effects
- Throat irritation
- Dizziness (vertigo)
- Burning feeling
Sumatriptan nasal spray serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Seizures
- Stroke: sudden weakness on one side of your body, headache, changes in your speech or vision, confusion
- Brain bleeds: sudden headache, nausea, vomiting, changes in vision or balance, weakness on one side of the body, trouble with movement
- 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
- Blood vessel spasms: bloody diarrhea, severe stomach pain, loss of vision, tightness or numbness of legs or feet
- Heart attack: dizziness, chest pain or tightness, cold sweat, heartburn, tiredness, nausea, trouble breathing
- Dangerously high blood pressure: anxiety, blurry vision, chest pain, feeling confused, headaches, nausea, vomiting
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The following Sumatriptan nasal spray side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
Less common
Abdominal or stomach pain
blurred vision
changes in patterns and rhythms of speech
chest pain or tightness
chills
confusion
dizziness
fast, slow, irregular, pounding, or racing heartbeat or pulse
headache
muscle cramps and stiffness
neck, throat, or jaw pain
nightmares
shivering
sweating
swelling of the fingers, hands, feet, or lower legs
tightness in the chest
trouble breathing
Rare
Blindness
chest pain or discomfort
chest tightness or heaviness
flushing or redness of the skin, especially on the face and neck
increased blinking or spasms of the eyelid
itching, pain, redness, or swelling
lightheadedness, dizziness, or fainting
nerve pain
severe numbness, especially on one side of the face or body
severe or continuing stomach pain
trouble speaking or swallowing
twitching
unusual bleeding or bruising
vomiting of blood or material that looks like coffee grounds
weakness of the arms and legs
Incidence not known
Agitation
back, leg, or stomach pains
bleeding gums
changes in vision
muscle twitching
pinpoint red spots on the skin
poor coordination
puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
restlessness
unexplained bleeding or bruising
unusually warm skin
weakness in the arm or leg on one side of the body, sudden and severe
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Less common
Burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
change in color vision
change in hearing
difficulty with concentrating
drowsiness
increased sensitivity of the eyes to sunlight
joint pain
muscle aching or cramping
muscle stiffness or tightness
swollen joints
trouble sleeping
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
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Pros and cons of Sumatriptan nasal spray
Pros
- Good for people who can't swallow pills or want to avoid injections
- Small and easy to carry around
- Available in different strengths
- Can start to work within about 15 minutes
- Lower-cost generic available (Imitrex brand name only)
Cons
- Can irritate the nose and throat
- Can't be used to prevent migraines
- Hasn't been studied in children
- Not used to treat cluster headaches like the sumatriptan (Imitrex) injection
- Can cause worse headaches if used 10 or more days per month
Pharmacist tips for Sumatriptan nasal spray
- Make sure you know how to use sumatriptan nasal spray to avoid wasting the medication and accidentally hurting yourself. Read the Instructions For Use for the medication you're prescribed (Imitrex (sumatriptan) and generic nasal spray or Tosymra (sumatriptan) nasal spray) and ask your provider or pharmacist if you have any questions.
- Sumatriptan nasal spray can cause nose or throat irritation. This should go away within 2 hours of taking the dose.
- Don't take the sumatriptan nasal spray unit out to test the spray. This medication only has 1 spray in each unit. The dose will be wasted if you test the spray.
- Let your provider know if sumatriptan nasal spray doesn’t give you any migraine relief after the first dose. They can help you find out what type of headache you have, and see if there might be better options for you.
- If you have migraines multiple times a month requiring treatment with sumatriptan nasal spray, let your provider know. They can consider other medication options to help with your symptoms. If appropriate, they can also recommend medications for migraine prevention.
- Don't use sumatriptan nasal spray alone or in combination with other migraine medications for 10 days or more in a month because it can make headaches worse. You might experience daily headaches or more frequent migraine attacks if this happens. Talk to your provider about additional options for migraine relief.
- Sumatriptan nasal spray interacts with a lot of commonly used medications. Make sure to let your provider and pharmacist know about all the medications you're taking (including vitamins and supplements) before starting sumatriptan nasal spray so that they can help you check for interactions. If there are any serious interactions, your provider might even switch you to a different migraine medication.
- Sumatriptan nasal spray can make you feel sleepy or dizzy. Don't drive or do anything that requires a lot of attention until you know how this medication affects you. Also, don't drink alcohol because this can worsen sleepiness and dizziness.
- You might feel tightness, pressure, or pain in the chest, throat, jaw, or neck after taking sumatriptan nasal spray. This usually doesn't last long and will go away. However, these symptoms are very similar to symptoms of a heart attack or heart problems. Tell your provider if you notice these symptoms and they'll let you know if you need more medical attention.
Common questions about Sumatriptan nasal spray
Yes, sumatriptan nasal spray can cause some people to feel dizzy or sleepy, but this isn't a common side effect. To be safe, it's best to avoid driving or performing activities that need your focus and attention until you know how this medication affects you.
No, sumatriptan nasal spray isn't a controlled substance because it doesn't have a known risk of addiction, misuse, or dependence (when your body relies on a medication to function normally).
How often you can use sumatriptan nasal spray depends on which product you're prescribed. If you're taking Imitrex or its generic version, you can use up to 2 doses of the medication, at least 2 hours apart (maximum 40 mg of sumatriptan in 24 hours). If you're taking Tosymra, you can use up to 3 doses, at least 1 hour apart (for a maximum of 30 mg of sumatriptan in 24 hours). To prevent rebound or medication-overuse headaches, you should only use sumatriptan nasal spray up to 4 a month. If you have migraines often, speak to your provider about treatment options to prevent migraines to help.
Sumatriptan nasal spray might start ease migraine pain within 10 minutes. But it can take up to 2 hours before you feel a more complete relief. Some people might need more than one dose of sumatriptan nasal spray. If you feel sumatriptan nasal spray isn't working well enough to relieve your migraine symptoms, let your provider know.
How long you experience the side effects of sumatriptan nasal spray can be influenced by the medication's half-life. Typically, it can take about 10 hours for the medication to leave your body. If you're having side effects, there's a chance that they might last this long. Let your provider know if you're having any side effects from sumatriptan nasal spray, especially if they're making it hard for you to get through the day. Your provider might recommend a lower dose of the medication, or talk with you about other options for migraine treatment and prevention.
Yes, it's possible to take sumatriptan nasal spray with acetaminophen (Tylenol) or nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen (Advil, Motrin). Sumatriptan nasal spray, acetaminophen (Tylenol), and NSAIDs work differently to relieve migraines and don't appear to interact with each other. Taking sumatriptan nasal spray with acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) can potentially work even better to relieve migraines than taking any of these medications alone. But, keep in mind that these other pain relievers also have their own risks (e.g., liver risks, heart risks, kidney problems). Before using other pain medications with sumatriptan nasal spray, speak with your healthcare provider to make sure it's safe for you to do so.
Talk to your provider about using sumatriptan nasal spray if you're pregnant because it isn't completely clear how safe sumatriptan nasal spray is during pregnancy. A report from a medical birth registry didn't show a clear link between sumatriptan nasal spray and harm to babies. But, animal studies show babies were harmed when born to mothers exposed to sumatriptan. To be safe, it's best to always discuss the risks and benefits of using sumatriptan nasal spray during pregnancy with your provider.
Research shows sumatriptan isn't expected to cause side effects in breastfed babies or affect breast milk production. But, the manufacturer of sumatriptan nasal spray recommends avoiding breastfeeding for at least 12 hours after taking a dose of the medication. Ask your provider if using sumatriptan nasal spray while breastfeeding is a safe option for you and your baby.
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Risks and warnings for Sumatriptan nasal spray
Sumatriptan nasal spray 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 | Age older than 65 | Diabetes | Identified as obese | High blood pressure | Smoking tobacco | Family history of heart disease
Although rare, some people have reported serious heart problems, such as heart attack and heart rhythm problems, within a few hours after taking sumatriptan nasal spray. In addition, sumatriptan nasal spray can raise your blood pressure, rarely to dangerously high levels. If you have a history of heart problems, talk to your provider first to make sure sumatriptan nasal spray is as safe for you as possible. Make sure to check your blood pressure periodically while you're taking sumatriptan nasal spray, and let your provider 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 sumatriptan nasal spray have experienced life-threatening strokes or bleeding in the brain. Symptoms of such brain injury include sudden weakness on one side of the body, bad 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 sumatriptan nasal spray. In addition, people who've had strokes before shouldn't take sumatriptan nasal spray. If you notice symptoms of a stroke, stop taking sumatriptan nasal spray and get medical help as soon as possible, especially if you haven't had a migraine before.
Blood vessel spasms
Sumatriptan nasal spray can cause blood vessel spasms in certain parts of your body. This can lead to serious stomach problems (e.g., stomach pain, bloody diarrhea), vision problems, and changes in sensation in your hands and feet. It can also lead to color changes in your hands and feet (can turn red, white, or bluish depending on how much blood is flowing through). If you notice these symptoms after taking sumatriptan nasal spray, don't take any more medication until you see a provider so they can check out what's going on.
Serotonin syndrome
- Risk factors: Taking other medications that raise serotonin levels in your brain
Some people taking sumatriptan nasal spray have developed a rare, but potentially life-threatening condition called serotonin syndrome. This condition happens where there's too much serotonin in the brain. Your risk for serotonin syndrome goes up if you use sumatriptan nasal spray with other medications that can raise your serotonin levels, such as certain antidepressants, mental health medications, pain medications, and migraine medications.
Let your provider know about all the medications you take before starting sumatriptan nasal spray, as well as any medications you plan to take. Symptoms of serotonin syndrome include fast heart rate, sweating, muscle stiffness or spasms, fever, and confusion. Get medical help right away if you have any of these symptoms.
Allergic reactions
Allergic reactions to sumatriptan nasal spray are possible, including life-threatening reactions like facial swelling, shock, and anaphylaxis (closing of the throat). If you notice dizziness, difficulty breathing, a choking sensation, nausea, swelling around your eyes, or swelling of the lips or tongue after using sumatriptan nasal spray, get medical attention as soon as possible.
Seizures
- Risk factors: History of seizures or epilepsy
Some people have had seizures after taking sumatriptan nasal spray. This has happened in people who have a history of seizures, but can also happen in people who've never had them as well. Get medical help right away if you have a seizure while taking sumatriptan nasal spray.
Nose or throat irritation
Sumatriptan nasal spray might cause irritation in the nose and throat, which can include burning, numbness, tingling sensation, runny nose, pain or soreness. These symptoms are usually temporary and goes away in less than 2 hours, but let your provider know if this continues to bother you.
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Sumatriptan nasal spray dosage
Nasal spray| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 6 unit doses of 20mg | 1 nasal spray | $73.98 | $73.98 |
| 6 unit doses of 5mg | 1 nasal spray | $107.00 | $107.00 |
Typical dosage for Sumatriptan nasal spray
-
Sumatriptan nasal spray: The typical dose is either 5 mg, 10 mg, or 20 mg. The 5-mg and 20-mg doses are given as a single spray in one nostril. The 10-mg dose is given by spraying 5 mg once in each nostril. If your migraine doesn't go away or comes back, you can take a second dose at least 2 hours after your first dose. The maximum dose is 40 mg in a 24-hour period.
-
Tosymra (sumatriptan) nasal spray: The typical dose is 10 mg given as a single spray in one nostril. If your migraine doesn't go away or comes back, you can take up to two more doses given at least 1 hour apart. The maximum dose is 30 mg in a 24-hour period.
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Interactions between Sumatriptan nasal spray and other drugs
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Almotriptan
- Bromocriptine
- Dihydroergotamine
- Eletriptan
- Ergoloid Mesylates
- Ergonovine
- Ergotamine
- Frovatriptan
- Furazolidone
- Iproniazid
- Isocarboxazid
- Linezolid
- Methylene Blue
- Methylergonovine
- Methysergide
- Moclobemide
- Naratriptan
- Nialamide
- Phenelzine
- Procarbazine
- Rasagiline
- Rizatriptan
- Safinamide
- Selegiline
- Tranylcypromine
- Zolmitriptan
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Alfentanil
- Amineptine
- Amitriptyline
- Amitriptylinoxide
- Amoxapine
- Amphetamine
- Benzhydrocodone
- Benzphetamine
- Buprenorphine
- Butorphanol
- Citalopram
- Clomipramine
- Codeine
- Desipramine
- Desvenlafaxine
- Dexfenfluramine
- Dextroamphetamine
- Dibenzepin
- Dihydrocodeine
- Dolasetron
- Doxepin
- Duloxetine
- Escitalopram
- Fenfluramine
- Fentanyl
- Fluoxetine
- Fluvoxamine
- Granisetron
- Hydrocodone
- Hydromorphone
- Imipramine
- Lasmiditan
- Levomilnacipran
- Levorphanol
- Lisdexamfetamine
- Lithium
- Lofepramine
- Lorcaserin
- Melitracen
- Meperidine
- Metaxalone
- Methamphetamine
- Milnacipran
- Mirtazapine
- Morphine
- Morphine Sulfate Liposome
- Nalbuphine
- Nefazodone
- Nortriptyline
- Ondansetron
- Opipramol
- Oxycodone
- Oxymorphone
- Palonosetron
- Paroxetine
- Pentazocine
- Protriptyline
- Reboxetine
- Remifentanil
- Sertraline
- Sibutramine
- St John's Wort
- Sufentanil
- Tapentadol
- Tianeptine
- Tramadol
- Trazodone
- Trimipramine
- Venlafaxine
- Vilazodone
- Vortioxetine
- Ziprasidone
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Sumatriptan nasal spray contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Sumatriptan nasal spray will not be safe for you to take.
- Coronary artery disease
- 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)
- Peripheral vascular disease
- Ischemic bowel disease
- 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)
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