From the Guidelines
Administration of sumatriptan (Imitrex) is generally not recommended in patients with suspected or confirmed glaucoma, as it may exacerbate the condition by causing vasoconstriction and potentially increasing intraocular pressure 1.
Key Considerations
- In patients presenting with migraine and possible concern for glaucoma, alternative treatments such as acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs) should be considered 1.
- If sumatriptan is deemed necessary, a thorough ophthalmologic evaluation should be performed prior to administration, and the patient should be closely monitored for signs of worsening glaucoma, with a typical dose of 25-100mg orally, not to exceed 200mg in a 24-hour period 1.
Rationale
- Migraine headache and peripheral vasospasm have been identified as risk factors for glaucomatous optic nerve damage, and sumatriptan may worsen this condition by causing vasoconstriction 1.
- The association between systemic arterial hypertension and glaucoma is controversial, but it is possible that increased perfusion of the ciliary body or decreased perfusion to the optic disc may contribute to the development of glaucoma 1.
Important Notes
- Patients with suspected or confirmed glaucoma should be closely monitored for signs of worsening glaucoma when taking sumatriptan, and alternative treatments should be considered whenever possible 1.
- A thorough ophthalmologic evaluation should be performed prior to administration of sumatriptan in patients with suspected or confirmed glaucoma 1.
From the Research
Safety of Imitrex (Sumatriptan) in Migraine with Suspected Glaucoma
- The use of selective serotonin 5-HT(1B/1D) receptor agonists, such as sumatriptan, is not recommended in elderly patients, even in the absence of cardiovascular or cerebrovascular risk 2.
- A case study reported a patient who developed non-arteritic anterior ischemic optic neuropathy (NAAION) after taking sumatriptan for migraine attacks, suggesting a potential risk of sumatriptan in patients with suspected glaucoma 3.
- There is limited evidence on the safety of sumatriptan in patients with glaucoma, but a study on the efficacy and safety of DFN-11 (sumatriptan injection, 3 mg) in adults with episodic migraine found that the incidence of treatment-emergent adverse events was low 4.
- Another study reviewed antimigraine drugs targeting 5-HT receptors, including sumatriptan, and found that lasmiditan, a 5-HT1F receptor agonist, represents a promising safe and effective acute migraine therapy, also for patients at cardiovascular risk 5.
Considerations for Patients with Suspected Glaucoma
- Patients with suspected glaucoma should be cautious when taking sumatriptan, as it may increase the risk of optic nerve ischemia 3.
- The use of sumatriptan in patients with glaucoma should be carefully evaluated, taking into account the potential benefits and risks, and alternative treatments should be considered 2.
- Further studies are needed to fully understand the safety and efficacy of sumatriptan in patients with glaucoma.