Imitrex 6mg Statdose Refills
It is used to treat migraine headaches. It is used to treat cluster headaches.
Drug Class
Antimigraine agent
Pharmacologic Class
Selective serotonin 5-HT1B/1D receptor agonist
Pregnancy Category
Category C
FDA Approved
Dec 1992
DEA Schedule
Not Controlled
Overview
What is this medicine?
Sumatriptan injection is a medication used to treat acute migraine headaches and cluster headaches. It works by narrowing blood vessels in the brain and affecting certain nerves, which helps to relieve headache pain and other symptoms like nausea and sensitivity to light and sound.
How to Use This Medicine
Taking Your Medication Correctly
To use this medication safely and effectively, follow your doctor's instructions carefully. Read all the information provided with your medication and follow the instructions closely. If your headache does not improve after the first dose, consult your doctor. If your headache improves but then returns, or if you only experience partial relief, you may take a second dose if your doctor has advised you to do so. Be sure to wait the recommended number of hours before taking another dose, even if you used a different form of this medication for the first dose.
Administering the Injection
The injection should be given under the skin as soon as possible after the attack begins. Before using this medication, make sure you understand how to administer it correctly. Read the package insert and instructions for use that come with your medication. If you have any questions, consult your doctor or pharmacist. It's also essential to know where to inject the medication. If you're unsure, consult your doctor.
Precautions and Safety Measures
Wash your hands before and after using the medication. Do not use the solution if it appears cloudy, is leaking, or contains particles. Also, do not use the solution if it has changed color. After use, dispose of the needle in a needle/sharp disposal box. Do not reuse needles or other items. When the box is full, follow local regulations for disposal. If you have any questions, consult your doctor or pharmacist.
Storage and Disposal
Store your medication at room temperature, avoiding refrigeration or freezing.
Missing a Dose
Since this medication is taken as needed, do not take it more frequently than directed by your doctor.
To use this medication safely and effectively, follow your doctor's instructions carefully. Read all the information provided with your medication and follow the instructions closely. If your headache does not improve after the first dose, consult your doctor. If your headache improves but then returns, or if you only experience partial relief, you may take a second dose if your doctor has advised you to do so. Be sure to wait the recommended number of hours before taking another dose, even if you used a different form of this medication for the first dose.
Administering the Injection
The injection should be given under the skin as soon as possible after the attack begins. Before using this medication, make sure you understand how to administer it correctly. Read the package insert and instructions for use that come with your medication. If you have any questions, consult your doctor or pharmacist. It's also essential to know where to inject the medication. If you're unsure, consult your doctor.
Precautions and Safety Measures
Wash your hands before and after using the medication. Do not use the solution if it appears cloudy, is leaking, or contains particles. Also, do not use the solution if it has changed color. After use, dispose of the needle in a needle/sharp disposal box. Do not reuse needles or other items. When the box is full, follow local regulations for disposal. If you have any questions, consult your doctor or pharmacist.
Storage and Disposal
Store your medication at room temperature, avoiding refrigeration or freezing.
Missing a Dose
Since this medication is taken as needed, do not take it more frequently than directed by your doctor.
Lifestyle & Tips
- Administer the injection as soon as headache symptoms begin, but not before the headache starts.
- Do not use for prevention of headaches.
- Do not use more than 2 injections (12 mg) in any 24-hour period.
- Avoid driving or operating machinery if you experience dizziness or drowsiness.
- Inform your doctor about all other medications you are taking, especially antidepressants, other migraine medications, or MAOIs.
- Avoid alcohol during a migraine attack as it can worsen symptoms or interact with medications.
Available Forms & Alternatives
Dosing & Administration
Adult Dosing
Standard Dose:
6 mg subcutaneous injection
Dose Range:
6 - 12 mg
Condition-Specific Dosing:
migraine:
6 mg subcutaneous injection. May repeat once after 1 hour if initial response is incomplete or headache recurs. Max 12 mg in 24 hours.
cluster_headache:
6 mg subcutaneous injection. Max 12 mg in 24 hours. (Note: Sumatriptan injection is indicated for acute treatment of cluster headache, but not for prevention.)
Pediatric Dosing
Neonatal:
Not established
Infant:
Not established
Child:
Not established (Safety and efficacy not established in patients under 18 years of age)
Adolescent:
Not established (Safety and efficacy not established in patients under 18 years of age)
Dose Adjustments
Renal Impairment:
Mild:
No dosage adjustment necessary
Moderate:
No dosage adjustment necessary
Severe:
No dosage adjustment necessary
Dialysis:
No specific recommendations; sumatriptan is not significantly removed by dialysis.
Hepatic Impairment:
Mild:
No dosage adjustment necessary
Moderate:
Use with caution; consider lower doses. (AUC may be increased)
Severe:
Contraindicated
Pharmacology
Mechanism of Action
Sumatriptan is a selective agonist for 5-hydroxytryptamine1 (5-HT1B/1D) receptors. It is believed to exert its antimigraine effects by causing vasoconstriction of cranial blood vessels, which are dilated during a migraine attack, and by inhibiting the release of pro-inflammatory neuropeptides from trigeminal nerve endings.
Pharmacokinetics
Absorption:
Bioavailability:
97% (subcutaneous)
Tmax:
12 minutes (subcutaneous)
FoodEffect:
Not applicable for injection
Distribution:
Vd:
2.7 L/kg
ProteinBinding:
14-21%
CnssPenetration:
Limited
Elimination:
HalfLife:
Approximately 2 hours
Clearance:
1160 mL/min (total plasma clearance)
ExcretionRoute:
Renal (approximately 60% as inactive metabolite, 3% as unchanged drug), Fecal (approximately 40% as inactive metabolite)
Unchanged:
3% (renal)
Pharmacodynamics
OnsetOfAction:
Approximately 10-15 minutes (subcutaneous)
PeakEffect:
Approximately 1 hour (subcutaneous)
DurationOfAction:
Up to 24 hours, but recurrence of headache is common
Safety & Warnings
Side Effects
Urgent Side Effects: Seek Medical Help Right Away
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor or seek immediate medical attention:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Note: In rare cases, allergic reactions can be fatal.
Signs of high blood pressure, including:
+ Severe headache
+ Dizziness
+ Fainting
+ Changes in eyesight
Seizures
Loss of vision (which can be long-lasting)
Abnormal sensations, such as:
+ Burning
+ Numbness
+ Tingling
Discoloration of the skin, lips, nail beds, fingers, or toes (blue or gray)
Gastrointestinal issues, including:
+ Diarrhea
+ Constipation
+ Severe stomach pain
+ Bloody diarrhea
Other symptoms, such as:
+ Belly pain after meals
+ Fever
+ Weight loss
+ Leg cramps or pain
+ Heaviness or tightness in the leg muscles
+ Feeling cold
+ Burning or aching pain in the feet or toes
Serotonin Syndrome: A Potentially Life-Threatening Condition
There is a risk of developing serotonin syndrome, a severe and potentially deadly condition, especially when taking certain other medications. If you experience any of the following symptoms, contact your doctor immediately:
Agitation
Changes in balance
Confusion
Hallucinations
Fever
Fast or abnormal heartbeat
Flushing
Muscle twitching or stiffness
Seizures
Shivering or shaking
Excessive sweating
Severe diarrhea
Upset stomach or vomiting
Severe headache
Brain Blood Vessel Problems: A Rare but Serious Risk
In rare cases, this medication can cause brain blood vessel problems, including stroke. If you experience any of the following symptoms, seek medical help right away:
Weakness on one side of the body
Trouble speaking or thinking
Changes in balance
Drooping on one side of the face
Changes in eyesight
Other Side Effects
Like all medications, this drug can cause side effects. While many people may not experience any side effects or only minor ones, it's essential to contact your doctor if you notice any of the following:
Dizziness
Drowsiness
Fatigue
Weakness
Flushing
Feeling of warmth
Upset stomach or vomiting
Irritation at the injection site
If you have any concerns about side effects or experience any symptoms that bother you or do not go away, contact your doctor for medical advice. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor or seek immediate medical attention:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Note: In rare cases, allergic reactions can be fatal.
Signs of high blood pressure, including:
+ Severe headache
+ Dizziness
+ Fainting
+ Changes in eyesight
Seizures
Loss of vision (which can be long-lasting)
Abnormal sensations, such as:
+ Burning
+ Numbness
+ Tingling
Discoloration of the skin, lips, nail beds, fingers, or toes (blue or gray)
Gastrointestinal issues, including:
+ Diarrhea
+ Constipation
+ Severe stomach pain
+ Bloody diarrhea
Other symptoms, such as:
+ Belly pain after meals
+ Fever
+ Weight loss
+ Leg cramps or pain
+ Heaviness or tightness in the leg muscles
+ Feeling cold
+ Burning or aching pain in the feet or toes
Serotonin Syndrome: A Potentially Life-Threatening Condition
There is a risk of developing serotonin syndrome, a severe and potentially deadly condition, especially when taking certain other medications. If you experience any of the following symptoms, contact your doctor immediately:
Agitation
Changes in balance
Confusion
Hallucinations
Fever
Fast or abnormal heartbeat
Flushing
Muscle twitching or stiffness
Seizures
Shivering or shaking
Excessive sweating
Severe diarrhea
Upset stomach or vomiting
Severe headache
Brain Blood Vessel Problems: A Rare but Serious Risk
In rare cases, this medication can cause brain blood vessel problems, including stroke. If you experience any of the following symptoms, seek medical help right away:
Weakness on one side of the body
Trouble speaking or thinking
Changes in balance
Drooping on one side of the face
Changes in eyesight
Other Side Effects
Like all medications, this drug can cause side effects. While many people may not experience any side effects or only minor ones, it's essential to contact your doctor if you notice any of the following:
Dizziness
Drowsiness
Fatigue
Weakness
Flushing
Feeling of warmth
Upset stomach or vomiting
Irritation at the injection site
If you have any concerns about side effects or experience any symptoms that bother you or do not go away, contact your doctor for medical advice. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Seek Immediate Medical Attention If You Experience:
- Sudden or severe chest pain, jaw pain, or neck pain (could be heart attack or angina)
- Shortness of breath
- Weakness or numbness on one side of the body, slurred speech, sudden vision changes (could be stroke)
- Severe stomach pain or bloody diarrhea (rare, but serious intestinal issues)
- Signs of serotonin syndrome: agitation, confusion, hallucinations, rapid heart rate, fever, sweating, muscle stiffness, twitching, loss of coordination, nausea, vomiting, diarrhea.
- Severe allergic reactions (rash, itching, swelling of face/tongue/throat, severe dizziness, trouble breathing).
Before Using This Medicine
Before Taking This Medication: Important Information to Share with Your Doctor
It is essential to inform your doctor about the following conditions to ensure safe treatment:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Describe the allergic reaction and its symptoms.
Certain health problems, including:
+ High blood pressure
+ Liver disease
A history of:
+ Chest pain or pressure
+ Diseased arteries in the legs or arms
+ Heart attack
+ Heart disease
+ Poor blood flow in the heart, brain, bowel, or kidney
+ Stroke or transient ischemic attack (TIA)
+ Specific types of migraines, such as hemiplegic or basilar migraines
+ Abnormal heart rhythms, like Wolff-Parkinson-White syndrome
Recent use of certain antidepressant medications, including isocarboxazid, phenelzine, or tranylcypromine, within the last 14 days. Taking this medication within 14 days of these drugs can lead to severe high blood pressure.
Concurrent use of another medication containing the same active ingredient.
Use of other medications for migraine or headache treatment, such as:
+ Almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, or zolmitriptan, within the last 24 hours
+ Ergotamine, methysergide, dihydroergotamine, or similar medications, within the last 24 hours
This list is not exhaustive, and it is crucial to inform your doctor and pharmacist about all your medications, including prescription and over-the-counter drugs, natural products, and vitamins, as well as any health problems. This will help ensure your safety while taking this medication. Never start, stop, or change the dose of any medication without consulting your doctor.
It is essential to inform your doctor about the following conditions to ensure safe treatment:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Describe the allergic reaction and its symptoms.
Certain health problems, including:
+ High blood pressure
+ Liver disease
A history of:
+ Chest pain or pressure
+ Diseased arteries in the legs or arms
+ Heart attack
+ Heart disease
+ Poor blood flow in the heart, brain, bowel, or kidney
+ Stroke or transient ischemic attack (TIA)
+ Specific types of migraines, such as hemiplegic or basilar migraines
+ Abnormal heart rhythms, like Wolff-Parkinson-White syndrome
Recent use of certain antidepressant medications, including isocarboxazid, phenelzine, or tranylcypromine, within the last 14 days. Taking this medication within 14 days of these drugs can lead to severe high blood pressure.
Concurrent use of another medication containing the same active ingredient.
Use of other medications for migraine or headache treatment, such as:
+ Almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, or zolmitriptan, within the last 24 hours
+ Ergotamine, methysergide, dihydroergotamine, or similar medications, within the last 24 hours
This list is not exhaustive, and it is crucial to inform your doctor and pharmacist about all your medications, including prescription and over-the-counter drugs, natural products, and vitamins, as well as any health problems. This will help ensure your safety while taking this medication. Never start, stop, or change the dose of any medication without consulting your doctor.
Precautions & Cautions
Important Warnings and Cautions for Patients Taking This Medication
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication. This will help ensure your safety and prevent potential interactions with other treatments.
Caution When Performing Daily Activities
Until you know how this medication affects you, avoid driving and other tasks that require alertness. This will help prevent accidents and ensure your safety.
Monitoring Blood Pressure
High blood pressure has been reported in patients taking this medication. Follow your doctor's instructions for regular blood pressure checks to monitor your condition.
Important Note on Migraine Headaches
This medication is not intended to prevent or reduce the frequency of migraine headaches. If you experience a headache that is different from your usual migraine headaches, consult your doctor before taking this medication.
Correct Dosage and Potential Risks
Taking more of this medication than prescribed by your doctor (higher dose, more frequent) may worsen your headaches. Be cautious if you have risk factors for heart disease, such as:
- High blood pressure
- High cholesterol
- Overweight
- High blood sugar or diabetes
- Cigarette smoking
- Male older than 40 years of age
- Family history of early heart disease
- Female after menopause
Discuss these risks with your doctor to ensure safe treatment.
Rare but Serious Heart Problems
In rare cases, this medication can cause severe and potentially life-threatening heart problems, including heart attack and abnormal heartbeat, within a few hours of taking the medication. Seek immediate medical attention if you experience:
- Chest, throat, neck, or jaw tightness, pain, pressure, or heaviness
- Cold sweat
- Shortness of breath
- Fast heartbeat
- Abnormal heartbeat
- Severe dizziness or fainting
Latex Allergy
If you have a latex allergy, inform your doctor, as some products may contain latex.
Special Considerations for Older Adults
If you are 65 or older, use this medication with caution, as you may be more susceptible to side effects.
Pregnancy, Breastfeeding, and Pediatric Use
Inform your doctor if you are pregnant, plan to become pregnant, or are breastfeeding, as you will need to discuss the benefits and risks to you and your baby. This medication is not approved for use in children; however, your doctor may decide that the benefits outweigh the risks. If your child has been prescribed this medication, ask your doctor about the benefits and risks, and discuss any concerns you may have.
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication. This will help ensure your safety and prevent potential interactions with other treatments.
Caution When Performing Daily Activities
Until you know how this medication affects you, avoid driving and other tasks that require alertness. This will help prevent accidents and ensure your safety.
Monitoring Blood Pressure
High blood pressure has been reported in patients taking this medication. Follow your doctor's instructions for regular blood pressure checks to monitor your condition.
Important Note on Migraine Headaches
This medication is not intended to prevent or reduce the frequency of migraine headaches. If you experience a headache that is different from your usual migraine headaches, consult your doctor before taking this medication.
Correct Dosage and Potential Risks
Taking more of this medication than prescribed by your doctor (higher dose, more frequent) may worsen your headaches. Be cautious if you have risk factors for heart disease, such as:
- High blood pressure
- High cholesterol
- Overweight
- High blood sugar or diabetes
- Cigarette smoking
- Male older than 40 years of age
- Family history of early heart disease
- Female after menopause
Discuss these risks with your doctor to ensure safe treatment.
Rare but Serious Heart Problems
In rare cases, this medication can cause severe and potentially life-threatening heart problems, including heart attack and abnormal heartbeat, within a few hours of taking the medication. Seek immediate medical attention if you experience:
- Chest, throat, neck, or jaw tightness, pain, pressure, or heaviness
- Cold sweat
- Shortness of breath
- Fast heartbeat
- Abnormal heartbeat
- Severe dizziness or fainting
Latex Allergy
If you have a latex allergy, inform your doctor, as some products may contain latex.
Special Considerations for Older Adults
If you are 65 or older, use this medication with caution, as you may be more susceptible to side effects.
Pregnancy, Breastfeeding, and Pediatric Use
Inform your doctor if you are pregnant, plan to become pregnant, or are breastfeeding, as you will need to discuss the benefits and risks to you and your baby. This medication is not approved for use in children; however, your doctor may decide that the benefits outweigh the risks. If your child has been prescribed this medication, ask your doctor about the benefits and risks, and discuss any concerns you may have.
Overdose Information
Overdose Symptoms:
- Convulsions
- Tremor
- Inactivity
- Erythema of the extremities
- Reduced respiratory rate
- Cyanosis
- Ataxia
- Mydriasis
- Paralysis
What to Do:
Call 911 or your local emergency number immediately. Contact a poison control center (1-800-222-1222). General supportive measures are necessary. Monitor for signs and symptoms of overdose for at least 12 hours. The effect of hemodialysis or peritoneal dialysis on sumatriptan plasma concentrations is unknown.
Drug Interactions
Contraindicated Interactions
- Monoamine oxidase inhibitors (MAOIs) or within 2 weeks of discontinuing MAOIs
- Ergotamine-containing medications or ergot-type drugs (e.g., dihydroergotamine) within 24 hours
- Other 5-HT1 agonists (e.g., other triptans) within 24 hours
Major Interactions
- Selective serotonin reuptake inhibitors (SSRIs) / Serotonin-norepinephrine reuptake inhibitors (SNRIs): Risk of serotonin syndrome
- Tricyclic antidepressants (TCAs): Risk of serotonin syndrome
Moderate Interactions
- Cimetidine: May increase sumatriptan levels (minor effect)
- Propranolol: No significant interaction
Confidence Interactions
Monitoring
Baseline Monitoring
Cardiovascular assessment (ECG, blood pressure)
Rationale: To rule out underlying cardiovascular disease, which is a contraindication or requires caution due to vasoconstrictive effects.
Timing: Prior to initiating therapy, especially in patients with risk factors for CAD.
Blood pressure
Rationale: To ensure controlled hypertension, as uncontrolled hypertension is a contraindication.
Timing: Prior to initiating therapy.
Routine Monitoring
Blood pressure
Frequency: Periodically, especially if patient has hypertension or risk factors.
Target: Within normal limits or controlled for the individual patient.
Action Threshold: Significant increase or uncontrolled readings warrant re-evaluation and potential discontinuation.
Migraine/headache frequency and severity
Frequency: Ongoing, with each dose
Target: Reduction in headache severity or resolution
Action Threshold: Lack of efficacy, increasing frequency of use, or medication overuse headache development.
Symptom Monitoring
- Chest pain or tightness (may indicate cardiac ischemia)
- Shortness of breath
- Jaw or neck tightness
- Dizziness or vertigo
- Tingling or numbness (paresthesia)
- Flushing
- Injection site reactions (pain, redness, swelling)
- Signs of serotonin syndrome (agitation, hallucinations, rapid heart rate, fever, overactive reflexes, nausea, vomiting, diarrhea, incoordination)
- Vision changes
- Weakness or numbness on one side of the body (signs of stroke)
Special Patient Groups
Pregnancy
Use during pregnancy only if the potential benefit justifies the potential risk to the fetus. Animal studies have shown adverse effects, but human data are limited.
Trimester-Specific Risks:
First Trimester:
Limited human data; animal studies show developmental toxicity.
Second Trimester:
Limited human data.
Third Trimester:
Limited human data.
Lactation
Sumatriptan is excreted into breast milk. Caution should be exercised when sumatriptan is administered to a nursing woman. Consider pumping and discarding breast milk for 8-12 hours after a dose to minimize infant exposure.
Infant Risk:
Low risk; monitor infant for drowsiness, poor feeding, or irritability.
Pediatric Use
Safety and efficacy have not been established in pediatric patients under 18 years of age. Not recommended for this population.
Geriatric Use
Use with caution in elderly patients (over 65 years) due to a greater likelihood of cardiovascular disease and increased sensitivity to adverse effects. Consider lower initial doses and careful monitoring.
Clinical Information
Clinical Pearls
- Sumatriptan injection is the fastest-acting triptan formulation, making it suitable for rapid relief of severe migraine or cluster headache.
- It is particularly useful for patients who experience nausea/vomiting with their migraines, making oral medications difficult to take.
- Patients should be instructed on proper injection technique and disposal of used syringes.
- Always screen patients for cardiovascular risk factors before prescribing triptans.
- Advise patients to avoid using sumatriptan for more than 10 days per month to prevent medication overuse headache.
Alternative Therapies
- Other triptans (e.g., zolmitriptan, rizatriptan, eletriptan, frovatriptan, naratriptan, almotriptan) in various formulations (oral, nasal spray, ODT)
- CGRP receptor antagonists (gepants like rimegepant, ubrogepant)
- Ditans (lasmiditan)
- NSAIDs (e.g., ibuprofen, naproxen)
- Acetaminophen
- Ergot alkaloids (e.g., ergotamine, dihydroergotamine)
- Anti-emetics (e.g., metoclopramide, prochlorperazine) for associated nausea/vomiting
Cost & Coverage
Average Cost:
Varies widely, typically $50-$150 per 6mg injection per 6mg injection
Generic Available:
Yes
Insurance Coverage:
Tier 2 or 3 (Brand), Tier 1 (Generic)
General Drug Facts
If your symptoms or health issues persist or worsen, it's essential to contact your doctor for further guidance. To ensure your safety, never share your medication with others or take someone else's medication. Some medications may come with an additional patient information leaflet, so be sure to check with your pharmacist for more information. If you have any questions or concerns about this medication, don't hesitate to discuss them with your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately call your local poison control center or seek emergency medical attention. When seeking help, be prepared to provide details about the overdose, including the medication taken, the amount, and the time it occurred.