Sumatriptan: Pharmacological Basis and Clinical Results

Carl G. H. Dahlöf

Disclosures

Curr Med Res Opin. 2001;17(1s) 

In This Article

Safety of Sumatriptan

Sometimes occurring in the chest area, the triptan sensations reported with sumatriptan stimulated a series of investigations designed to determine whether the symptoms were vascular in origin. Data from studies employing angiography, electrocardiography, and positron emission tomography of the heart do not suggest that the chest symptoms sometimes reported with sumatriptan are generally attributable to ischaemic mechanisms[12]. The mechanisms of these and other triptan sensations have not been determined, although several hypotheses have been advanced[41]. It has been hypothesized that migraine patients may suffer from a generalized vasospastic disorder, the coronary manifestation of which is variant angina and the cerebral vascular manifestation of which is migraine headache[42]. Oesophageal or pulmonary mechanisms have also been hypothesized to underlie the chest symptoms sometimes reported with sumatriptan and other triptans[43,44]. A recent report of chest symptoms following administration of an experimental 5-HT1D agonist devoid of vasoconstrictive action at the coronaries supports a non-vascular mechanism for these symptoms[45].

Post-marketing data from the use of sumatriptan in clinical practice are useful in complementing the data from these mechanistic studies. Through December 1998, sumatriptan was used to treat an estimated 340 million migraine attacks in world-wide clinical practice involving more than 9 million patient exposures[17]. Although similar information is not available for other triptans, these data with sumatriptan may be useful in guiding prescribing decisions involving the triptan class. Post-marketing data (which should be cautiously interpreted because of the inability to estimate precisely the number of exposures to a drug) suggest that the frequency of serious cardiovascular adverse events with sumatriptan is approximately 1 in 1 million treated attacks. Serious adverse events most often occurred in patients with contraindications to sumatriptan.

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