Common Side Effects of Sumatriptan (Imitrex)
The most common side effects of sumatriptan include tingling or numbness in fingers or toes, warm or cold sensations, feeling weak, drowsy, or tired, pain/discomfort in the neck, throat, jaw, or chest, and dizziness. 1
Primary Side Effect Profile
Sumatriptan, a selective serotonin 5-HT1B/1D receptor agonist used for acute migraine treatment, has a well-documented side effect profile:
Common Non-Serious Side Effects
- Tingling or numbness in fingers or toes
- Warm or cold sensations
- Weakness, drowsiness, or fatigue
- Pain, discomfort, or stiffness in neck, throat, jaw, or chest
- Dizziness
- Nausea and vomiting
- Malaise
Administration-Specific Side Effects
- Subcutaneous injection: Injection site reactions (minor pain and redness) occur in approximately 40% of patients, though this can be reduced with auto-injector use 2
- Oral administration: Nausea, vomiting, malaise, fatigue, and dizziness are most commonly reported 1
Serious Side Effects (Less Common)
While generally well-tolerated, sumatriptan can cause serious adverse effects that require immediate medical attention:
Cardiovascular Effects
- Chest symptoms (tightness, pressure) occur in 3-5% of patients 2
- Risk of heart attack in susceptible individuals
- Changes in color or sensation in fingers and toes (Raynaud's syndrome) 1
Neurological Effects
- Seizures (even in patients without prior history) 1
- Serotonin syndrome (especially when combined with SSRIs, SNRIs, TCAs, or MAOIs) 1
Gastrointestinal Effects
- Stomach and intestinal problems (gastrointestinal and colonic ischemic events) 1
- Symptoms include sudden/severe stomach pain, pain after meals, weight loss, nausea/vomiting, constipation/diarrhea, bloody diarrhea, fever
Other Serious Concerns
- Problems with blood circulation to legs and feet (peripheral vascular ischemia) 1
- Medication overuse headaches with excessive use 1
- Allergic reactions including hives and swelling of tongue, mouth, or throat 1
Contraindications
Sumatriptan should not be used in patients with:
- Heart problems or history of heart disease
- Uncontrolled hypertension
- Severe liver problems
- Hemiplegic or basilar migraines
- Recent stroke or TIA
- Use of other triptans or ergotamine-containing medications within 24 hours 1
Clinical Pearls
Patients should try sumatriptan for 2-3 headache episodes before determining its effectiveness 3
If recurrence of migraine occurs (approximately 40% of attacks), it typically happens within 8-12 hours and can be treated with a second dose 4
Do not exceed maximum dosing limits:
Triptans should be held on the day of surgical procedures due to potential drug interactions 4
Monitor for medication overuse headaches in patients using sumatriptan frequently 1
Patients with risk factors for heart disease (high blood pressure, high cholesterol, smoking, obesity, diabetes, family history) should be evaluated before using sumatriptan 1
By understanding these side effects and taking appropriate precautions, patients can safely use sumatriptan for effective migraine relief while minimizing adverse effects.