Is Sumatriptan (sumatriptan) suitable for pediatric patients?

From the Guidelines

Sumatriptan is not generally recommended as a first-line treatment for children with migraines, but for adolescents aged 12-17, sumatriptan nasal spray may be prescribed under careful medical supervision. The evidence base for medication therapy in children and adolescents is confounded by a high placebo response in clinical trials, which probably explains why a benefit of triptans has not been demonstrated in children 1. For adolescents aged 12-17, multiple NSAIDs and triptans have been approved for acute treatment of migraine, and some evidence indicates that nasal spray formulations of sumatriptan and zolmitriptan are the most effective 1.

Key Considerations

• Alternative first-line treatments for pediatric migraines include ibuprofen (10mg/kg) 1.
• If medication is needed, treatment should begin at the lowest effective dose and be used only when necessary.
• Sumatriptan works by constricting blood vessels in the brain and blocking pain pathways, but it carries risks of side effects including chest tightness, dizziness, and fatigue, which can be more concerning in children.
• Any migraine treatment for children should be managed by a pediatrician or pediatric neurologist who can properly evaluate the child's condition, recommend appropriate lifestyle modifications like regular sleep schedules and hydration, and monitor for medication effectiveness and side effects.

Treatment Approach

• Take a detailed history and make a specific headache diagnosis 1.
• Advise patients and families on lifestyle factors, migraine triggers, and avoidance of acute medication overuse 1.
• Counsel patients to treat acute migraine early in the attack 1.
• Consider preventive treatments in children/adolescents with frequent or disabling headaches or medication overuse 1.

From the FDA Drug Label

Safety and effectiveness in pediatric patients have not been established. Sumatriptan tablets are not recommended for use in patients younger than 18 years of age. The frequency of all adverse reactions in these patients appeared to be both dose - and age-dependent, with younger patients reporting reactions more commonly than older adolescents Postmarketing experience documents that serious adverse reactions have occurred in the pediatric population after use of subcutaneous, oral, and/or intranasal sumatriptan. These reports include reactions similar in nature to those reported rarely in adults, including stroke, visual loss, and death A myocardial infarction has been reported in a 14-year-old male following the use of oral sumatriptan; clinical signs occurred within 1 day of drug administration.

Sumatriptan is not recommended for use in pediatric patients. The safety and effectiveness of sumatriptan in patients younger than 18 years of age have not been established, and serious adverse reactions have been reported in the pediatric population after use of the drug 2.

From the Research

Sumatriptan for Kids

• There is limited information available on the use of sumatriptan in children, as most studies have focused on adult populations 3, 4, 5, 6.
• One study found that acetaminophen is suitable for mild to moderate migraine attacks and remains the first choice for children and pregnant women 3.
• Another study discussed the use of cognitive behavioral therapy plus amitriptyline for chronic migraine in children and adolescents, but did not mention sumatriptan 7.
• The available evidence suggests that sumatriptan is effective in treating migraine attacks in adults, but its use in children is not well established 4, 5, 6.
• More research is needed to determine the safety and efficacy of sumatriptan in pediatric populations.

Available Treatments for Migraine in Children

• Acetaminophen is considered a suitable treatment option for mild to moderate migraine attacks in children 3.
• Cognitive behavioral therapy plus amitriptyline may be effective in reducing days with headache and migraine-related disability in children and adolescents with chronic migraine 7.
• Other treatment options, such as sumatriptan, may be considered for children with migraine, but more research is needed to establish their safety and efficacy in this population 4, 5, 6.

Considerations for Sumatriptan Use in Children

• The use of sumatriptan in children is not well established, and more research is needed to determine its safety and efficacy in this population 3, 4, 5, 6.
• Sumatriptan is generally well tolerated in adults, but its adverse event profile in children is not well understood 5, 6.
• The dosage and formulation of sumatriptan that would be appropriate for children are not established, and more research is needed to determine the optimal treatment approach for this population 4, 5, 6.