From the Guidelines
Sumatriptan (Imitrex) is contraindicated in patients with ischemic heart disease, stroke, peripheral vascular disease, or uncontrolled hypertension, as well as in those with hemiplegic or basilar migraine, severe hepatic impairment, or hypersensitivity to the medication. The contraindications to sumatriptan can be summarized as follows:
- Ischemic heart disease, including coronary artery disease and history of myocardial infarction
- Cerebrovascular syndromes, including stroke and transient ischemic attacks
- Peripheral vascular disease
- Uncontrolled hypertension
- Hemiplegic or basilar migraine
- Severe hepatic impairment
- Hypersensitivity to sumatriptan or any component of the formulation
- Use within 24 hours of another triptan medication or an ergot-containing/ergot-type medication
- Use in patients taking monoamine oxidase inhibitors (MAOIs) within 14 days of MAOI use These contraindications are based on the medication's mechanism of action, which involves stimulating serotonin receptors to cause vasoconstriction, and can be dangerous in patients with existing vascular disease or conditions that increase vulnerability to serotonergic effects 1. It is essential to carefully evaluate patients for these contraindications before prescribing sumatriptan to minimize the risk of adverse effects and ensure safe use. Key considerations include:
- Careful assessment of cardiovascular risk factors and history
- Evaluation of cerebrovascular and peripheral vascular disease
- Monitoring of blood pressure and hepatic function
- Avoidance of concomitant use with other triptans, ergot-containing medications, or MAOIs
- Patient education on potential risks and benefits of sumatriptan use.
From the FDA Drug Label
Sumatriptan tablets are contraindicated in patients with: Ischemic coronary artery disease (CAD) (angina pectoris, history of myocardial infarction, or documented silent ischemia) or coronary artery vasospasm, including Prinzmetal’s angina Wolff-Parkinson-White syndrome or arrhythmias associated with other cardiac accessory conduction pathway disorders History of stroke or transient ischemic attack (TIA) or history of hemiplegic or basilar migraine Peripheral vascular disease Ischemic bowel disease Uncontrolled hypertension Recent use (i.e., within 24 hours) of ergotamine-containing medication, ergot-type medication (such as dihydroergotamine or methysergide), or another 5-hydroxytryptamine1 (5-HT1) agonist Concurrent administration of a monoamine oxidase (MAO)-A inhibitor or recent (within 2 weeks) use of an MAO-A inhibitor Hypersensitivity to sumatriptan tablets (angioedema and anaphylaxis seen) Severe hepatic impairment
The contraindications to sumatriptan are:
- Ischemic heart disease: including angina, history of myocardial infarction, or silent ischemia
- Cardiac arrhythmias: including Wolff-Parkinson-White syndrome
- History of stroke or TIA: including hemiplegic or basilar migraine
- Peripheral vascular disease
- Ischemic bowel disease
- Uncontrolled hypertension
- Recent use of ergotamine or other 5-HT1 agonists
- Concurrent use of MAO-A inhibitors
- Hypersensitivity to sumatriptan
- Severe hepatic impairment 2
From the Research
Contraindications to Sumatriptan
The following are contraindications to sumatriptan:
- History, symptoms, or signs of ischemic vascular disease 3
- Patients at high risk for adverse cardiovascular events due to its vasoconstrictor activity 4
- Cardiovascular disease, as sumatriptan has vasoconstricting properties 5, 6
- Coronary artery disease, as the drug may cause myocardial ischemia at therapeutic plasma concentrations in these patients 6
- Patients with endothelial dysfunction, as sumatriptan may potentiate vasoconstriction in the presence of thromboxane A2 7
Special Considerations
- An in-depth evaluation should be carried out in subjects at intermediate cardiovascular risk before prescribing sumatriptan 3
- The drug should be used with caution in patients with risk factors for cardiovascular disease, as it may increase the risk of severe cardiovascular adverse events 3, 4
- Sumatriptan is contraindicated in patients with a history of myocardial infarction, ischemic heart disease, or other cardiovascular conditions 3, 6, 7