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Sumatriptan and zolmitriptan

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VOL: 101, ISSUE: 39, PAGE NO: 31

Generic and proprietary names

 

Generic and proprietary names
- Zomig (zolmitriptan).

 

 

- Imitrex (sumatriptan).

 

 

Action
- Zolmitriptan and sumatriptan are both triptans or 5HT1 (serotonin) agonists.

 

 

- Triptans bind to specific serotonin receptors, reducing blood vessel dilation and the inflammation and pain of migraine.

 

 

Classification
- Antimigraine drugs.

 

 

Indications

 

 

- Used to relieve migraine symptoms. They are not suitable for the prevention of migraine.

 

 

- Sumatriptan, via subcutaneous injection, can be used for cluster headaches.

 

 

Contraindications
- Not for use as prophylaxis.

 

 

- Ischaemic heart disease.

 

 

- History of myocardial infarction.

 

 

- History of cerebrovascular accident or transient ischaemic attacks.

 

 

- Angina.

 

 

- Uncontrolled hypertension.

 

 

Cautions
- Conditions that predispose to coronary artery disease.

 

 

- Hepatic impairment.

 

 

- Pregnancy and breastfeeding.

 

 

- Older people.

 

 

- Other migraine therapies.

 

 

Common side-effects
- Tingling, heat or pressure sensations.

 

 

- Flushing.

 

 

- Weakness or sensation of heaviness.

 

 

- Fatigue.

 

 

- Drowsiness.

 

 

- Nausea and vomiting.

 

 

- Chest pain.

 

 

- Nasal discomfort or irritation from the nasal spray preparations.

 

 

Interactions
- Monoamine oxidase inhibitors and some other antidepressant medication.

 

 

- Some antiviral, antifungal and antibacterial medications.

 

 

- Ergotamine.

 

 

Administration
- Oral.

 

 

- Intranasal.

 

 

- Sumatriptan is available as subcutaneous injection.

 

 

- Usually only one dose is needed, but a second may be taken after at least two hours (one hour for injection).

 

 

- Currently this is prescription-only medication, but proposals to change this are being considered.

 

 

Nursing considerations
- Assess for side-effects of tingling, burning, numbness, flushing or feeling of pressure.

 

 

- Assess stress level and mechanisms for coping with migraine.

 

 

- Assess avoidance of factors predisposing to migraine, such as caffeine and chocolate, and give appropriate advice.

 

 

- Provide a calm environment during migraine attack.

 

 

- Assess therapeutic response and need for second dose.

 

 

Patient teaching
- Inform patients of the importance of only using their medication for a headache that they recognise as a migraine.

 

 

- Medication should be taken as soon as the headache pain begins. Patients who have an aura stage should wait until the headache pain starts before taking the medication.

 

 

- These drugs may cause drowsiness, so ensure that patients are aware not drive or operate machinery if affected.

 

 

Nurses should refer to manufacturer’s summary of product characteristics and to appropriate local guidelines

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