Sumatriptan is a drug that is used for treating migraine headaches. It belongs to a class of drugs called selective serotonin receptor agonists.

Other medications in this drug class include:

• naratriptan (Amerge)
• zolmitriptan (Zomig)
• rizatriptan (Maxalt)
• frovatriptan (Frova)
• eletriptan (Relpax)
• almotriptan (Axert)

Migraine headaches are believed to result from dilatation of blood vessels in the brain. Sumatriptan relieves a migraine by stimulating serotonin receptors in the brain, which cause the muscles surrounding the blood vessels in the brain to contract and narrow the blood vessels. At the same time, also it reduces transmission of pain signals by nerves to the brain. While it is very effective in relieving migraine headaches, it does not prevent or reduce the number of headaches. This drug is not used for treatment of other types of headache pain.

The FDA approved sumatriptan inhalation powder (Onzetra Xsail) in January, 2016.

• Onzetra Xsail is the brand name for sumatriptan nasal powder in the US.

• No, this drug is not available as a generic.

• Yes, a prescription is necessary for this migraine drug.

• Sumatriptan nasal powder is used for the acute treatment of migraine headaches with or without an aura in adults.

Common side effects include:

• Nausea
• Vomiting
• Abnormal taste
• Nasal discomfort
• Runny nose
• Common cold
• Other side effects include:
• Throat discomfort
• Dizziness

Possible serious side effects include:

• Heart attack, chest pain (myocardial ischemia/infarction and Prinzmetal's angina)
• Abnormal heart beats
• Chest, throat, neck and/or jaw pain/tightness/pressure
• Stroke
• Vasospasm reactions
• Medication overuse headache (rebound headache)
• Serotonin syndrome
• Increase in blood pressure
• Stomach and intestinal problems (GI ischemia and infarction events, peripheral vasospastic reactions)
• Seizures
• Cerebral hemorrhage, subarachnoid hemorrhage, and stroke

• The recommended dosage for this drug is 2 nosepieces (22 mg) administered using the Xsail breath-powered delivery device.
• Two additional nosepieces may be used after 2 hours if the migraine headache has not resolved, or returns after some improvement.
• The maximum dose over a 24 hour period is 2 doses (44 mg or 4 nosepieces) or 1 dose of sumatriptan inhalation powder and 1 dose of another sumatriptan product, separated by at least 2 hours.

• Monoamine oxidase inhibitors or MAOIs, for example, isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate), and procarbazine (Matulane), may reduce the breakdown of sumatriptan in the liver, leading to increased blood levels and side effects of sumatriptan.
• Combining sumatriptan with sibutramine (Meridia, which has been removed from the market), selective serotonin reuptake inhibitors or SSRIs, including fluoxetine (Prozac), citalopram (Celexa), paroxetine (Paxil), and sertraline (Zoloft) or serotonin and norepinephrine reuptake inhibitors, including venlafaxine (Effexor), duloxetine (Cymbalta), and desvenlafaxine (Pristiq) may increase the concentration of serotonin in the brain causing increased serotonin-related side effects.
• Administering a dose of sumatriptan within 24 hours of treatment with an ergot-containing medication (dihydroergotamine [Migranal], ergotamine [Methergine]) is contraindicated because such combinations increase the likelihood of spasm of arteries.

• Safe use of sumatriptan while pregnant has not been established.
• Sumatriptan is excreted in breast milk. Infant exposure may be reduced by avoiding breastfeeding for 12 hours after administration of sumatriptan.

What preparations of sumatriptan nasal powder are available?

• Intranasal powder: 11 mg (capsule in disposable nosepiece)

Sumatriptan is available in the following forms:

• intranasal powder (Onzetra Xsail)
• intranasal spray (Imitrex Intranasal): 5mg, 20mg
• injection (Imitrex, Imitrex StatDose): 4 and 6mg/.05ml
• trandermal patch (Zecuity): 86 mg (6.5 over 4 hours)
• tablets: 25mg, 50mg, 100mg

How should I keep sumatriptan nasal powder stored?

• Sumatriptan intranasal powder should be stored at room temperature, between 20 C and 25 C (68 F and 77 F).
• The nosepiece should be used immediately after removing it from the foil pouch.