Side Effects of Sumatriptan (Imitrex)
Sumatriptan commonly causes tingling/numbness in fingers or toes, warm/cold sensations, weakness, drowsiness, fatigue, pain or discomfort in the neck/throat/jaw/chest, and dizziness. 1
Common Side Effects
Neurological effects:
- Tingling or numbness in fingers and toes
- Dizziness
- Drowsiness and fatigue
- Paresthesia (abnormal sensations)
- Headache
Cardiovascular effects:
- Chest discomfort, pressure, or tightness (occurs in 3-5% of patients) 2
- Warm or cold sensations
Gastrointestinal effects:
- Nausea and vomiting
- Unpleasant taste (with intranasal formulation) 3
Serious Side Effects
Cardiovascular Concerns
- Changes in color or sensation in fingers and toes (Raynaud's syndrome)
- Gastrointestinal and colonic ischemic events (symptoms include sudden stomach pain, pain after meals, weight loss, nausea/vomiting, constipation/diarrhea) 1
- Problems with blood circulation to legs and feet (peripheral vascular ischemia)
Neurological Concerns
- Serotonin syndrome (especially when used with SSRIs or SNRIs)
- Symptoms include mental changes, hallucinations, agitation, fast heartbeat, high body temperature, tight muscles, trouble walking 1
- Seizures (can occur even in patients with no history of seizures)
Other Serious Concerns
- Medication overuse headache with frequent use
- Allergic reactions (hives, swelling of tongue, mouth, or throat) 1
Administration Routes and Side Effect Profiles
Different routes of administration have varying side effect profiles:
Subcutaneous (6 mg): Most effective but highest incidence of adverse events 4
- Injection site reactions occur in approximately 40% of patients 2
Oral (25-100 mg): Moderate side effect profile
- At the 12.5 mg dose (almotriptan), adverse events profile was similar to placebo 5
Intranasal (5-20 mg): Common side effect is unpleasant taste 3
Contraindications
Sumatriptan is contraindicated in patients with:
- Ischemic heart disease or coronary artery disease
- Previous myocardial infarction
- Uncontrolled hypertension
- Hemiplegic or basilar migraine
- Use within 24 hours of another triptan or ergotamine-containing medication
- Use of MAO inhibitors
- Severe hepatic impairment
- Pregnancy 6
Practical Considerations
- Most adverse events are transient and mild to moderate in severity 2
- The safety of treating more than 4 headaches in a 30-day period has not been established 6
- Chest symptoms have not generally been associated with myocardial ischemia except in a few isolated cases 2
- Limiting acute therapy to no more than twice per week may help prevent medication-overuse headache 3