What is Imitrex

Imitrex is a brand name of a drug called sumatriptan, which is used to treat the symptoms of vascular headaches and migraine headaches (severe, throbbing headaches that sometimes are accompanied by nausea or sensitivity to sound and light). Imitrex is not used to prevent migraine headaches and is not used for cluster headaches. Imitrex is in a class of medications called selective serotonin receptor agonists (triptans). Imitrex (sumatriptan) works by narrowing blood vessels in your head, stopping pain signals from being sent to the brain, and blocking the release of certain natural substances that cause pain, nausea, and other symptoms of migraine. Imitrex does not prevent migraine attacks or reduce the number of headaches you have.

Imitrex is available only with your doctor’s prescription.

Many people find that their headaches go away completely after they take Imitrex. Other people find that their headaches are much less painful, and that they are able to go back to their normal activities even though their headaches are not completely gone. Imitrex often relieves other symptoms that occur together with a migraine headache, such as nausea, vomiting, sensitivity to light, and sensitivity to sound.

Imitrex is not an ordinary pain reliever. It will not relieve pain other than from migraine headaches. This medicine is usually used for people whose headaches are not relieved by acetaminophen, aspirin, or other pain relievers.

Imitrex (sumatriptan) comes as a tablet to take by mouth. Imitrex (sumatriptan) is usually taken at the first sign of a migraine headache. If your symptoms improve after you take Imitrex but return after 2 hours or longer, you may take a second tablet. However, if your symptoms do not improve after you take Imitrex (sumatriptan), do not take a second tablet without calling your doctor. Your doctor will tell you the maximum number of tablets you may take in a 24-hour period. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take Imitrex exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

You may take your first dose of Imitrex in a doctor’s office or other medical facility where you can be monitored for serious reactions.

Call your doctor if your headaches do not get better or occur more frequently after taking Imitrex.

If you take Imitrex more often or for longer than the recommended period of time, your headaches may get worse or may occur more frequently. You should not take Imitrex or any other headache medication for more than 10 days per month. Call your doctor if you need to take Imitrex to treat more than four headaches in a 1-month period.

Imitrex has caused serious side effects in some people, especially people who have heart or blood vessel disease. Be sure that you discuss with your doctor the risks of using this medicine as well as the benefits that it can have.

How does Imitrex work?

Imitrex (sumatriptan) is a serotonin receptor agonist that is useful in the therapy of vascular headaches and migraine. Serotonin (5-hydroxytryptamine or 5-HT) is a monoamine that has multiple actions, acting as a neurotransmitter and bioactive amine. The diversity of actions of serotonin is partially due to the multitude of different serotonin receptors and their tissue location. There are at least 15 classes of serotonin receptors which have overlapping actions, but variable distribution and intracellular pathways of response to stimulation and inhibition. Imitrex (sumatriptan) is a serotonin agonist with high affinity for the 5-HT1B and 5-HT1D receptors which are found on smooth-muscle cells of blood vessels. Simulation of the 5-HT1D receptor results in constriction of intracranial blood vessels. Imitrex (sumatriptan) may also block the release of vasoactive peptides from perivascular trigeminal neurons through their action at presynaptic 5-HT1D receptors on nerve terminals. Regardless, Imitrex (sumatriptan) has been found to be effective in preventing or aborting migraine headaches with shortening of the period of pain and symptoms. Imitrex (sumatriptan) is considered “first line” agent for patients whose vascular headaches do not reliably respond to conventional analgesics. Imitrex (sumatriptan) generally has a more rapid onset of action and fewer side effects than the ergot alkaloids and generally provides relief within 30 to 60 minutes. Intranasal formulations may have a more rapid onset of action as do subcutaneous administered forms.

Imitrex nasal spray

Use Imitrex nasal spray only as directed by your doctor. Do not use more of it, do not use it more often, and do not use it for a longer time than your doctor ordered. Using too much Imitrex may increase the chance of side effects.

Imitrex nasal spray is for use only in the nose. Do not get any of it into your eyes or on your skin. If it does get on these areas, rinse it off right away.

Do not use Imitrex nasal spray for a headache that is different from your usual migraines. Instead, check with your doctor.

To relieve your migraine as soon as possible, use this medicine as soon as the headache pain begins. Even if you get warning signals of a coming migraine (an aura), you should wait until the headache pain starts before using Imitrex.

Ask your doctor ahead of time about any other medicine you might take if Imitrex does not work. After you take the other medicine, check with your doctor right away. Headaches that are not relieved by Imitrex are sometimes caused by conditions that need other treatments.

If you feel much better after a dose of Imitrex nasal spray, but your headache comes back or gets worse after a while, you may use one additional dose of sumatriptan at least 2 hours after the first dose. Do not use more than 3 doses in any 24-hour period.

Imitrex nasal spray comes with a patient information leaflet and patient instructions. Read and follow the instructions carefully. Ask your doctor if you have any questions.

To use the Imitrex nasal powder:

1. Imitrex is given through the Xsail™ breath-powered delivery device.
2. Remove the disposable nosepiece from its foil pouch, then remove the clear device cap from the reusable delivery device, and click the nosepiece into the device body. Use the nosepiece immediately after removing from the foil pouch.
3. Fully press and release the white piercing button on the device body to pierce the capsule inside the nosepiece. Press it only once.
4. Insert the nosepiece into the nostril so that it makes a tight seal. The device is then rotated and the mouthpiece inserted between the lips.
5. Blow forcefully through the mouthpiece to deliver the medicine into the nasal cavity. Do not press the white button while blowing.
6. Press the clear tab to remove the first nosepiece. Throw the used nosepiece in the trash can.
7. Repeat the same steps using a second nosepiece into the other nostril to complete the recommended dose.

To use the Imitrex nasal spray:

1. Gently blow your nose to clear the nostrils before you use this medicine.
2. Gently press one nostril to close it.
3. Hold the device upright between your thumb and first 2 fingers. Insert half of the spray nozzle into the open nostril and angle outward.
4. Tilt your head back slightly.
5. Firmly press the plunger all the way up as you slowly breathe through your nose.
6. Remove the device from your nostril. Keep your head upright and gently breathe in through your nose and breathe out through your mouth. Repeat this for 10 to 20 seconds. You may feel liquid in your nose or at the back of your throat.
7. Do not look down as this may cause the medicine to drip from your nose.

Imitrex nasal spray dosage

The dose of Imitrex nasal spray will be different for different patients. Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of Imitrex nasal spray. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of Imitrex nasal spray that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

For Imitrex nasal dosage form (nasal powder):

For migraine headaches:

• Adults—22 milligrams (mg) (1 nosepiece in each nostril, total of 2 nosepieces) per day. Another dose (22 mg) may be used as long as it has been at least 2 hours since the last spray. Do not use more than 44 mg (4 nosepieces) in a 24-hour period (one day).
• Children—Use and dose must be determined by your doctor.

For Imitrex nasal dosage form (nasal solution):

For migraine headaches:

• Imitrex®:
  • Adults—5 milligrams (mg) (1 spray into one nostril) or 10 mg (2 sprays in one nostril or 1 spray in each nostril) or 20 mg (1 spray into one nostril). Another spray (5 mg, 10 mg, or 20 mg) may be used as long as it has been at least 2 hours since the last spray. Do not use more than 40 mg in a 24-hour period (one day).
  • Children—Use and dose must be determined by your doctor.

Imitrex injection

Imitrex injection is used to treat acute migraine attacks and cluster headaches in adults. Many people find that their headaches go away completely after they use Imitrex. Other people find that their headaches are much less painful, and that they are able to go back to their normal activities even though their headaches are not completely gone. Imitrex often relieves other symptoms that occur together with a migraine headache, such as nausea, vomiting, sensitivity to light, and sensitivity to sound.

Imitrex is not an ordinary pain reliever. It will not relieve any kind of pain other than migraine headaches. This medicine is usually used for people whose headaches are not relieved by acetaminophen, aspirin, or other pain relievers.

Imitrex has caused serious side effects in some people, especially in those who have heart or blood vessel disease. Be sure that you discuss with your doctor the risks of using this medicine as well as its benefits.

Imitrex injection is available only with your doctor’s prescription.

Imitrex injection is available in the following dosage forms:

• Solution
• Kit

Imitrex injection is available in 3 forms. You may use a single dose vial, prefilled syringe, or a prefilled autoinjector.

Do not use Imitrex injection if it is dark colored or cloudy.

After you have finished injecting the Imitrex injection, be sure to follow the precautions in the patient directions about safely discarding the empty cartridge and the needle. Always return the empty cartridge and needle to their container before discarding them. Do not throw away the autoinjector unit, because refills are available.

Imitrex injection comes with a patient information leaflet. Read and follow the instructions carefully. Ask your doctor if you have any questions.

Imitrex injection dosage

The dose of this medicine will be different for different patients. Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

For Imitrex injection dosage form:

For migraine or cluster headaches:

• Adults: 4 or 6-milligram (mg) injected under the skin. If the headache comes back after being relieved, one more dose may be injected after 1 hour. Do not use more than 2 doses of 6-mg, or 3 doses of 4-mg in any 24-hour period.
• Children—Use and dose must be determined by your doctor.

Imitrex special precautions

Before taking Imitrex:

• tell your doctor and pharmacist if you are allergic to Imitrex, any other medications, or any of the ingredients in Imitrex tablets. Ask your pharmacist for a list of the ingredients.
• do not take Imitrex if you have taken any of the following medications in the past 24 hours: other selective serotonin receptor agonists such as almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), or zolmitriptan (Zomig); or ergot-type medications such as bromocriptine (Parlodel), cabergoline, dihydroergotamine (D.H.E. 45, Migranal), ergoloid mesylates (Hydergine), ergonovine (Ergotrate), ergotamine (Cafergot, Ergomar, Wigraine), methylergonovine (Methergine), methysergide (Sansert), and pergolide (Permax).
  do not take Imitrex if you are taking a monoamine oxidase A (MAO-A) inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), or tranylcypromine (Parnate) or if you have taken one of these medications in the past 2 weeks.
• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: acetaminophen (Tylenol); antidepressants such as amitriptyline (Elavil), amoxapine (Asendin), clomipramine (Anafranil), desipramine (Norpramin), doxepin (Adapin, Sinequan), imipramine (Tofranil), nortriptyline (Aventyl, Pamelor), protriptyline (Vivactil), and trimipramine (Surmontil); aspirin and other nonsteroidal anti-inflammatory medications (NSAIDs) such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn); selective serotonin reuptake inhibitors (SSRIs) such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem, in Symbyax), fluvoxamine, paroxetine (Paxil), and sertraline (Zoloft); and selective serotonin/norepinephrine reuptake inhibitors (SNRIs) such as desvenlafaxine (Pristiq), duloxetine (Cymbalta), sibutramine (Meridia), and venlafaxine (Effexor). Your doctor may need to change the doses of your medications or monitor you more carefully for side effects.
• tell your doctor if you have or have ever had heart disease; a heart attack; angina (chest pain); irregular heartbeats; stroke or ‘mini-stroke’; or circulation problems such as varicose veins, blood clots in the legs, Raynaud’s disease (problems with blood flow to the fingers, toes, ears, and nose), or ischemic bowel disease (bloody diarrhea and stomach pain caused by decreased blood flow to the intestines). Your doctor may tell you not to take Imitrex.
• tell your doctor if you smoke or are overweight; if you have or have ever had high blood pressure, high cholesterol, diabetes, seizures, or liver or kidney disease; if you have gone through menopause (change of life); or if any family members have or have ever had heart disease or stroke.
• tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you plan to be sexually active while you are using this medication,
• talk to your doctor about effective methods of birth control. If you become pregnant while taking Imitrex, call your doctor.
• you should know that this medication may make you drowsy or dizzy. Do not drive a car or operate machinery until you know how this medication affects you.
• Using Imitrex alone or in combination with other migraine medicines for 10 or more days per month may lead to worsening of headache. You may keep a headache diary to record your headache frequency and drug use.

Pediatric

Appropriate studies have not been performed on the relationship of age to the effects of Imitrex in the pediatric population. Safety and efficacy have not been established.

Geriatric

Use of Imitrex is not recommended in elderly patients with kidney problems, heart or blood vessel disease, or high blood pressure, and should not be used by elderly patients with liver problems.

Breastfeeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Drug Interactions

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 Imitrex, 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 Imitrex 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 Imitrex 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
• Fentanyl
• Fluoxetine
• Fluvoxamine
• Granisetron
• Hydrocodone
• Hydromorphone
• Imipramine
• Levomilnacipran
• Levorphanol
• Lisdexamfetamine
• Lithium
• Lofepramine
• Lorcaserin
• Melitracen
• Meperidine
• Metaxalone
• Methamphetamine
• Milnacipran
• Mirtazapine
• Morphine
• Morphine Sulfate Liposome
• Nalbuphine
• Nefazodone
• Nortriptyline
• 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

Other Interactions

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Drinking alcoholic beverages can make headaches worse or cause new headaches to occur. People who suffer from severe headaches should probably avoid alcoholic beverages, especially during a headache.

Medical Problems

The presence of other medical problems may affect the use of Imitrex. Make sure you tell your doctor if you have any other medical problems, especially:

• Angina (chest pain) or
• Arrhythmia (heart rhythm problem) or
• Basilar migraine (migraine with vision and hearing problems) or
• Cerebrovascular disease (eg, stroke, transient ischemic attack), or history of or
• Heart attack, history of or
• Heart or blood vessel problems or
• Hemiplegic migraine (migraine with some paralysis) or
• Hypertension (high blood pressure), uncontrolled or
• Ischemic bowel disease (bowels have low blood supply) or
• Liver disease, severe or
• Peripheral vascular disease (clogged arteries) or
• Stroke, history of or
• Transient ischemic attack (TIA), history of or
• Wolff-Parkinson-White Syndrome (heart rhythm problem)—Should not be used in patients with these conditions.
• Seizures or epilepsy, history of or
• Stomach or intestinal bleeding—Use with caution. May make these conditions worse.
• Coronary artery disease, history of or
• Diabetes or
• Hypercholesterolemia (high cholesterol in the blood) or
• Hypertension (high blood pressure), controlled or
• Liver disease, mild to moderate or
• Obesity or
• Raynaud’s syndrome—Use with caution. May be at increased risk for more serious side effects.

Imitrex dosage

The recommended dose of Imitrex tablets is 25 mg, 50 mg, or 100 mg. Doses of 50 mg and 100 mg may provide a greater effect than the 25-mg dose, but doses of 100 mg may not provide a greater effect than the 50-mg dose. Higher doses may have a greater risk of side effects.

If the migraine has not resolved by 2 hours after taking Imitrex tablets, or returns after a transient improvement, a second dose may be administered at least 2 hours after the first dose. The maximum daily dose is 200 mg in a 24-hour period.

For oral dosage form (tablets):

For migraine headaches:

• Adults—25, 50, or 100 milligrams (mg) as a single dose. If you get some relief, or if the migraine comes back after being relieved, another dose may be taken 2 hours after the last dose. Do not take more than 200 mg in any 24-hour period.
• Children—Use and dose must be determined by your doctor.

Use after Imitrex injection

If the migraine returns following an initial treatment with Imitrex (sumatriptan succinate) injection, additional single Imitrex tablets (up to 100 mg/day) may be given with an interval of at least 2 hours between tablet doses.

The safety of treating an average of more than 4 headaches in a 30-day period has not been established.

Dosing in patients with hepatic impairment

If treatment is deemed advisable in the presence of mild to moderate hepatic impairment, the maximum single dose should not exceed 50 mg.

Imitrex side effects

Imitrex may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• flushing
• tingling feeling
• feeling warm or cold
• drowsiness
• tiredness
• weakness
• dizziness
• upset stomach
• diarrhea
• nausea
• muscle cramps

Some side effects can be serious. If you experience any of the following symptoms, call your doctor immediately or get emergency medical treatment:

• pain, tightness, pressure, or heaviness in the chest, throat, neck, and/or jaw
• slow or difficult speech
• faintness
• breaking out in a cold sweat
• shortness of breath
• weakness or numbness of an arm or leg
• sudden or severe stomach pain
• fast, pounding, or irregular heartbeat
• bloody diarrhea
• vomiting
• sudden or severe stomach pain
• sudden weight loss
• paleness or blue color of the fingers and toes
• difficulty breathing or swallowing
• redness, swelling, or itching of the eyes, face, lips, or throat
• rash
• hives
• change in vision
• seizures

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.