Evigrade
DrugsCosmetic ingredientsCalculatorsInteractionsEvigrade SkinEvigrade Meds ↗
ConditionsJournalMethodologyPro for practitioners
ESRU

Sumatriptan

AEMPS

Selective 5-HT1B/1D serotonin receptor agonist

ATC code: N02CC01

Updated · Methodology

Indications

A

Acute migraine attack

First line

First-line for moderate-to-severe migraine attacks per AHS 2024 and EFNS 2022. The Cochrane meta-analysis showed pain-free response at 2 hours with sumatriptan 100 mg in 38% versus 17% on placebo. Subcutaneous 6 mg gives 70% pain-free response – highest efficacy among triptans. Take at the first sign of pain, not during aura. In pregnant migraineurs, sumatriptan has the largest data set among triptans and is preferred when needed.

Sources

  1. AEMPS: Ficha técnica de Sumatriptán (2024)
  2. Cochrane Database Syst Rev: Sumatriptan (all routes of administration) for acute migraine attacks in adults - overview of Cochrane reviews. (2014)
  3. Headache: The American Headache Society Consensus Statement: Update on integrating new migraine treatments into clinical practice. (2021)

ICD-10: G43.9 · ICD-11: 8A80.Z

Marketing claims without evidence base

The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.

F

Memory and concentration enhancement

Not recommended

Sumatriptan is a triptan (a serotonin 5-HT1B/1D receptor agonist). It is prescribed for migraine and cluster headache ( NG150 2021, AHS 2021, and AEMPS Ficha Técnica). For tension-type headache, stress-related headache, hangover, or premenstrual headache, sumatriptan is not indicated and may worsen the picture: regular use for non-migraine headache provokes medication-overuse headache. The drug is contraindicated in ischemic heart disease, prior stroke, and uncontrolled hypertension; coronary vasospasm has been reported in susceptible patients on triptans. If sumatriptan was prescribed for any severe headache outside a migraine or cluster headache indication, consider seeking a second opinion.

Sources

  1. AEMPS: Ficha técnica de Sumatriptán (2024)
  2. Cochrane: Ginkgo biloba for cognitive impairment and dementia (2009)
How to read tiers A–F
  • AStrong evidence – first or second line in international guidelines
  • BRecommended in selected cases
  • CStudy data contradict each other
  • DBenefit not proven, no documented harm
  • FDocumented harm, or risk without benefit

Mechanism of action

A selective 5-HT1B/1D agonist. Constricts dilated cranial vessels via 5-HT1B and blocks release of inflammatory neuropeptides (CGRP, substance P) from trigeminal nerve endings via 5-HT1D. The first triptan on the market (1991), the «gold standard» benchmark for other triptans. Onset 30 minutes (tablets), 10–15 minutes (subcutaneous), 15 minutes (nasal spray). Half-life 2 hours.

Safety

Contraindications

  • Sumatriptan hypersensitivity
  • Coronary artery disease, prior MI
  • Uncontrolled hypertension
  • History of cerebrovascular events (stroke, TIA)
  • Peripheral arterial disease
  • Hemiplegic, basilar, or ophthalmoplegic migraine
  • Severe hepatic or renal impairment
  • Concurrent MAO inhibitors or within 14 days of stopping
  • Concurrent ergotamines or other triptans

Serious adverse effects

  • Coronary spasm, MI (rare, in predisposed patients)
  • Cerebrovascular events
  • Serotonin syndrome with SSRIs/SNRIs
  • Anaphylaxis
  • Medication-overuse headache with overuse

Common adverse effects

  • Chest, neck, or jaw tightness or pressure
  • Drowsiness
  • Dizziness
  • Nausea
  • Warmth or flushing
  • Injection-site reactions (subcutaneous)

Pregnancy: can you take Sumatriptan?

AEMPS summary of product characteristics (section 4.6): post-marketing data cover first-trimester use of sumatriptan in more than 1,000 women; they are insufficient for definitive conclusions but do not indicate an increased risk of birth defects. Experience in the second and third trimesters is limited. Animal studies show no direct teratogenic effects or harm to peri- and postnatal development, although embryofetal viability was affected in rabbits. Sumatriptan is considered only if the expected benefit outweighs any possible risk to the fetus.

Breastfeeding: can you take Sumatriptan?

Hale L2 · Probably compatible

Fully compatible. Hale L2. RID 3.5%. Best-studied triptan during breastfeeding. After 100 mg sumatriptan, feeding may be delayed 4–8 h for extra safety, although no clinically significant infant effects have been reported.

RID, infant dose via milk
3.5%
Maternal half-life
2 h
Maternal peak time
2.3 h
Peak milk concentration
0.09 mg/L
Milk-to-plasma ratio
4.9
Calculate RIDSafe feeding windowFull profile on NIH LactMed ↗

Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.

Practical notes

Timing and administration

Take at the first sign of pain. Standard tablet dose 50 or 100 mg; a repeat dose is allowed at 2 hours if pain returns, max 300 mg per day. Subcutaneous injection (Imigran SC autoinjector) for severe attacks with rapid nausea, max 2 injections per day. Nasal spray as an alternative with marked nausea. Use exceeding 10 days per month risks medication-overuse headache.

Drug–drug interactions

6 pairs found. Sorted from critical to minor.

CriticalDihydroergotamineErgot alkaloid, 5-HT1B/1D and alpha-adrenoceptor agonist

Mechanism

Both are 5-HT1B/1D vasoconstrictors. Additive coronary and peripheral vasospasm. – at least 24-hour washout.

Symptoms

Myocardial ischaemia, stroke within hours.

Management

Combination contraindicated. At least 24 hours between doses.

Sources

Pair details →Dihydroergotamine →

CriticalErgotamineErgot alkaloid, 5-HT1B/1D and alpha-adrenoceptor agonist

Mechanism

Both drugs are 5-HT1B/1D vasoconstrictors. Additive effect on coronary and peripheral arteries. requires at least 24-hour separation.

Symptoms

Myocardial ischaemia, stroke, digital ischaemia within hours.

Management

Combination contraindicated. At least 24 hours between ergotamine and any triptan.

Sources

Pair details →Ergotamine →

CriticalPhenelzineAntidepressant, irreversible non-selective monoamine oxidase inhibitor (MAO-A and MAO-B)

Mechanism

Sumatriptan is a 5-HT1B/1D agonist, partly metabolised by MAO-A. Phenelzine irreversibly inhibits MAO – sumatriptan accumulates and excess serotonin triggers fatal serotonin syndrome.

Symptoms

Agitation, tachycardia, hyperthermia, myoclonus, hyperreflexia within hours.

Management

Combination contraindicated. 14 days after MAOI withdrawal before starting triptan.

Sources

Pair details →Phenelzine →

CriticalSelegilineSelective irreversible MAO-B inhibitor

Mechanism

Selegiline at high doses loses MAO-B selectivity and inhibits MAO-A. Serotonin syndrome risk with triptans.

Symptoms

Agitation, tachycardia, hypertension.

Management

The AEMPS label for selegiline lists the combination with triptans as contraindicated because of serotonin syndrome. For a migraine attack on selegiline, use paracetamol or an NSAID.

Sources

Pair details →Selegiline →

CriticalTranylcypromineAntidepressant, irreversible non-selective monoamine oxidase inhibitor (MAO-A and MAO-B), amphetamine derivative

Mechanism

Tranylcypromine irreversibly inhibits MAO-A. Sumatriptan accumulates – fatal serotonin syndrome.

Symptoms

Agitation, tachycardia, hyperthermia, myoclonus, hyperreflexia within hours.

Management

Combination contraindicated. 14 days after MAOI withdrawal before starting triptan.

Sources

Pair details →Tranylcypromine →

ModerateSertralineSelective serotonin reuptake inhibitors (SSRIs)

Mechanism

Theoretical serotonin syndrome risk with SSRI + triptan. revised the recommendation in 2018 (previously CONTRA) – clinical cases at standard doses are few. Still, monitoring is needed at first use.

Symptoms

Rarely – agitation, tremor, myoclonus. Mainly with high triptan doses or SNRI combination.

Management

The AEMPS label for sertraline describes rare postmarketing cases of weakness, hyperreflexia and confusion, without banning the pair. Acceptable at standard doses. Inform patient of possible symptoms.

Sources

Pair details →Sertraline →

Label mentions19 mentions

Verbatim lines from the interaction sections, in the language of the label

From this drug’s label

  • CriticalDihydroergotamine
    «CONTRAINDICATIONS: Recent use (i.e., within 24 hours) of ergotamine-containing medication, ergot-type medication (such as dihydroergotamine or methysergide), or another 5-hydroxytryptamine 1 (5-HT 1…»

    FDA, section 4 · Open on DailyMed

  • CriticalErgotamine
    «Está contraindicada la administración concomitante de ergotamina o derivados de la ergotamina (incluyendo metisergida) o algún triptán/agonista del receptor 5-hidroxitriptamina (5-HT1) (ver sección…»

    AEMPS, section 4.3 · Open on CIMA

  • CriticalErgotamine
    «CONTRAINDICATIONS: Recent use (i.e., within 24 hours) of ergotamine-containing medication, ergot-type medication (such as dihydroergotamine or methysergide), or another 5-hydroxytryptamine 1 (5-HT 1…»

    FDA, section 4 · Open on DailyMed

  • CriticalIMAOclass named in the label
    «Está contraindicada la administración concomitante de sumatriptán con inhibidores de la monoaminooxidasa (IMAOs).»

    AEMPS, section 4.3 · Open on CIMA

  • ModerateISRSclass named in the label
    «Tras la comercialización se han notificado casos raros de pacientes con síndrome serotoninérgco (incluyendo estado mental alterado, inestabilidad autonómica y alteraciones neuromusculares) tras el…»

    AEMPS, section 4.4 · Open on CIMA

  • Moderatemedicamentos serotoninérgicosclass named in the label
    «Tras la comercialización se han notificado casos raros de pacientes con síndrome serotoninérgco (incluyendo estado mental alterado, inestabilidad autonómica y alteraciones neuromusculares) tras el…»

    AEMPS, section 4.4 · Open on CIMA

  • ModerateNicotine
    «Sumatriptán no se debe administrar a pacientes con factores de riesgo de enfermedad isquémica cardiaca incluyendo aquellos pacientes que fuman grandes cantidades de tabaco al dia o los que usan…»

    AEMPS, section 4.4 · Open on CIMA

  • Flunarizine
    «No existen evidencias de interacciones con propranolol, flunarizina, pizotifeno o alcohol.»

    AEMPS, section 4.5 · Open on CIMA

  • Propranolol
    «No existen evidencias de interacciones con propranolol, flunarizina, pizotifeno o alcohol.»

    AEMPS, section 4.5 · Open on CIMA

  • SSRIs/SNRIsclass named in the label
    «Other 5-HT1 Agonists: Selective Serotonin Reuptake Inhibitors/Serotonin Norepinephrine Reuptake Inhibitors and Serotonin Syndrome»

    FDA, section 7 · Open on DailyMed

From other drugs’ labels

  • CriticalMoclobemide
    «La administración conjunta de Manerix con triptanos está contraindicada ya que éstos son potentes receptores agonistas serotoninérgicos metabolizados por las monoaminooxidasas (MAOs) y varios enzimas…»

    AEMPS, section 4.5 · Open on CIMA

  • CriticalRizatriptan
    «Ergotamina, derivados de la ergotamina (incluyendo metisérgida) y otros agonistas de los receptores 5 HT 1B/1D : Debido a un efecto aditivo, el uso concomitante de rizatriptán y ergotamina, derivados…»

    AEMPS, section 4.5 · Open on CIMA

  • CriticalSelegiline
    «Agonistas de la serotonina: La selegilina no debe utilizarse en combinación con agonistas de la serotonina (por ejemplo, sumatriptán, naratriptán, zolmitriptán, rizatriptán, lasmiditán) debido al…»

    AEMPS, section 4.5 · Open on CIMA

  • MajorCitalopram
    «Hasta que no se disponga de más información, no se recomienda el uso simultáneo de citalopram y de agonistas 5- HT tales como sumatriptán y otros triptanes (ver sección 4.4).»

    AEMPS, section 4.5 · Open on CIMA

  • ModerateEscitalopram
    «Medicamentos serotoninérgicos: La administración conjunta con medicamentos serotoninérgicos (p.ej. tramadol, sumatriptán y otros triptanes) puede provocar un síndrome serotoninérgico.»

    AEMPS, section 4.5 · Open on CIMA

  • ModerateSertraline
    «Triptanes: Durante la experiencia post-comercialización se han notificado casos raros en los que se describían pacientes con debilidad, hiperreflexia, descoordinación, confusión, ansiedad y agitación…»

    AEMPS, section 4.5 · Open on CIMA

  • Escitalopram
    «DRUG INTERACTIONS: Sumatriptan»

    FDA, section 7 · Open on DailyMed

  • Topiramate
    «Concentración de Topiramato a: Sumatriptán (oral y subcutáneo)»

    AEMPS, section 4.5 · Open on CIMA

  • Vortioxetine
    «Medicamentos serotoninérgicos: La administración conjunta de medicamentos con efecto serotoninérgico por ejemplo opiáceos (entre ellos, tramadol) y triptanes (entre ellos, sumatriptán), puede…»

    AEMPS, section 4.5 · Open on CIMA

Check interaction with another drug

Opens the checker prefilled with this drug. Pick the second one from your regimen.

Open checker

Summary of a multi-drug list →

Medicine list: everything you take in one place →

Frequently asked

What is Sumatriptan used for?

Sumatriptan is evaluated for the following indications with varying evidence strength: Migraine during breastfeeding (evidence tier A), Acute migraine attack (evidence tier A), Memory and concentration enhancement (evidence tier F). See the full indication matrix with dosing and citations above on this page.

What are the side effects of Sumatriptan?

Common side effects of Sumatriptan (≥ 1 in 100): Chest, neck, or jaw tightness or pressure, Drowsiness, Dizziness, Nausea, Warmth or flushing, Injection-site reactions (subcutaneous). See the Safety section for uncommon and serious reactions.

Is Sumatriptan safe during pregnancy?

AEMPS summary of product characteristics (section 4.6): post-marketing data cover first-trimester use of sumatriptan in more than 1,000 women; they are insufficient for definitive conclusions but do not indicate an increased risk of birth defects. Experience in the second and third trimesters is limited. Animal studies show no direct teratogenic effects or harm to peri- and postnatal development, although embryofetal viability was affected in rabbits. Sumatriptan is considered only if the expected benefit outweighs any possible risk to the fetus.

Is Sumatriptan compatible with breastfeeding?

Fully compatible. Hale L2. RID 3.5%. Best-studied triptan during breastfeeding. After 100 mg sumatriptan, feeding may be delayed 4–8 h for extra safety, although no clinically significant infant effects have been reported.

Who should not take Sumatriptan?

Sumatriptan is contraindicated in: Sumatriptan hypersensitivity; Coronary artery disease, prior MI; Uncontrolled hypertension; History of cerebrovascular events (stroke, TIA); Peripheral arterial disease. Full list in the Safety section.

Official sources

Direct links to regulator labels. Open in a new tab.

Other drugs in this group

Tapentadol, Tramadol, Tramadol + Paracetamol, Zolmitriptan, Eletriptan, Meperidine, Oxycodone, Almotriptan