Imitrex

What is Imitrex?

Imitrex is a brand-name drug used to treat migraine headaches with or without aura. The generic drug is sumatriptan.

What You Need To Know About Migraines

Imitrex belongs to a class of drugs known as selective serotonin receptor agonists (triptans). It causes blood vessels in the head to narrow, which stops pain signals from being sent to the brain. It also blocks the release of certain substances that cause migraine symptoms, including pain, nausea, and hypersensitivity to light and sound.¹

Warnings and precautions

The US Food and Drug Administration (FDA) warns of serious adverse effects with Imitrex use. This include:²

• Myocardial ischemia/infarction and Prinzmetal’s angina — you will undergo cardiac evaluation if you are at risk of cardiovascular events

• Arrhythmias (abnormal heart rhythm) — Imitrex must be discontinued if arrhythmias occur

• Pain, tightness, or pressure in the chest, throat, neck, and/or jaw. These symptoms could indicate a heart problem. Your doctor will evaluate you for coronary artery disease if you are at risk.

• Cerebral hemorrhage, subarachnoid hemorrhage, and stroke — Imitrex must be discontinued if these adverse effects occur

• Peripheral vasospastic reactions or gastrointestinal ischemic reaction — Imitrex must be discontinued if these adverse effects occur

• Medication overuse headache — you will need to undergo detoxification guided by your doctor

• Serotonin syndrome — Imitrex must be discontinued if this occurs

• Seizures — Imitrex should be used with caution if you have epilepsy or a lowered seizure threshold

Imitrex is contraindicated in the following conditions:

• Past diagnosis of coronary artery disease (including any history of myocardial infarction, angina, or silent ischemia), or history of coronary artery vasospasm

• Wolff-Parkinson-White syndrome (a serious skin condition) or other disorders of the cardiac accessory conduction pathway

• Past diagnosis of stroke, hemiplegic or basilar migraine, or transient ischemic attack

• Peripheral vascular disease

• Ischemic bowel disease

• Uncontrolled high blood pressure (hypertension)

• Hypersensitivity to Imitrex (some people have experienced allergic reactions like angioedema and anaphylaxis)

• Severe liver impairment

Do not take Imitrex if:

• You have taken another 5-HT1 agonist (such as another triptan) or a medication containing ergotamine in the last 24 hours.

• You are currently taking a monoamine oxidase-A inhibitor (MAOI) or have taken one in the last two weeks.

What does Imitrex treat?

Imitrex is used to treat migraine headaches. It helps relieve severe pain and other symptoms, like nausea, vomiting, and sensitivity to light and sound.

Imitrex won’t prevent migraine headaches or reduce the number of migraine headaches you get.

The Imitrex injection is also indicated to treat cluster headaches.

Dosage forms and strengths

The drug comes in different strengths and formats, including:

• Tablets for oral use: 25mg, 50mg, or 100mg

• Nasal spray: 5mg or 20mg

• Injection (pre-filled single-dose cartridges for use with Imitrex Statdose auto-injector pen): 4mg or 6mg

How do you take Imitrex?

Imitrex works best if taken at the first sign of a migraine attack when your headache is still mild.

Do not take more Imitrex than what is prescribed by your doctor. Your dosage will depend on the severity of your condition, the form of Imitrex you take, and other medical conditions you may have.

How to take Imitrex tablets

Swallow the tablet whole with a glass of water. You can take it with or without food.

If you don’t feel any better after two hours of taking your dose, or you only feel relief for a short time, you can take a second dose. Do not take a second dose within two hours of your first dose.

You must not take more than 200mg in 24 hours.²

How to use Imitrex nasal spray

To take a 5mg or 20mg dose, spray once in one nostril. To take 10mg, spray 5mg in each nostril.

If you don’t feel any better after two hours of taking your dose, or you only feel relief for a short time, you can take one additional dose. Do not take a second dose within two hours of your first dose.

You must not take more than 40mg in 24 hours.³

How to take Imitrex injections

Imitrex injections are usually administered in the emergency department for severe acute migraine or cluster headache attacks.

6mg will be administered under the skin. Your doctor may recommend taking the lower dose of 4mg to treat migraine headaches, but the efficacy of this dose for cluster headaches is unknown.

You should not take more than 12mg cumulatively over 24 hours. Two 6mg injections must be taken at least one hour apart.

Only consider taking a second 6mg dose if you notice some response to the first. This is because Imitrex in this form could quickly cause severe adverse effects, particularly if your diagnosis is incorrect and your headache is a symptom of a different condition where Imitrex is contraindicated.⁴

Seeing results

Imitrex tablets work within 30–60 minutes; the injection provides relief in 10–15 minutes; the nasal spray works within 15 minutes.⁵

Who should not take Imitrex

This drug is not suitable for people who:

• Want to take medication to prevent migraine headaches — this drug only helps ease the symptoms

• Have hemiplegic or basilar migraines

• Have uncontrolled high blood pressure

• Have heart problems or a history of heart problems

• Have serious liver problems

• Have a history of stroke, blood circulation problems, or transient ischemic attacks

• Have peripheral vascular disease (narrowing of blood vessels in your legs, arms, stomach, or kidneys)

• Have taken one of these medications in the last 24 hours: frovatriptan (Frova), eletriptan (Relpax), almotriptan (Axert), rizatriptan (Maxalt or Maxalt MLT), naratriptan (Amerge), sumatriptan and naproxen (Treximet), ergotamines (Cafergot, Ergomar, or Migergot) or dihydroergotamine (DHE-45 injection, Trudhesa nasal spray, or Migranal nasal spray)

• Are younger than 18 years of age

Potential side effects of Imitrex

Like all medicines, Imitrex can cause side effects. Most common side effects disappear as your body adjusts to the drug.

Common side effects

Imitrex tablets can cause the following common side effects:²

• Tiredness

• A sensation of pain, tightness, pressure, or heaviness in the chest and/or throat

• Vertigo

• Feeling cold or warm

• A tingling sensation

Imitrex nasal spray can cause the following common side effects:³

• A burning sensation

• Irritation in your nose or throat

• Nausea and/or vomiting

• Dizziness

• Vertigo

• An unpleasant or unusual taste

The Imitrex injection can cause the following common side effects:⁴

• A tingling sensation

• A burning sensation

• Feeling warm or hot

• Feeling tightness, heaviness, or pressure

• Feeling unusual

• Tightness in the head

• Numbness

• Flushing

• Feeling tightness, pressure, or discomfort in the chest

• Irritation in your nose or throat

• Irritation at the injection site (pain, redness, and swelling)

• Jaw discomfort

• Stiffness or pain in the neck

• Weakness

• Myalgia (muscle pain or aches)

• Dizziness/vertigo

• Drowsiness

• Headache

• Sweating

This list is not exhaustive, and other side effects may occur. Talk to your doctor if these symptoms persist, worsen, or bother you.

Serious side effects

Imitrex can cause severe side effects. Call your doctor immediately or seek medical assistance if you experience any of the following serious side effects:

• Heart problems, including myocardial ischemia, myocardial infarction (heart attack), and Prinzmetal’s angina. You may experience chest discomfort, pain or discomfort in your arms, back, neck, jaw, or stomach, shortness of breath, cold sweats, nausea, or lightheadedness.⁶

• Arrhythmias (irregular heartbeat). You may experience heart palpitations, anxiety, confusion, pain or discomfort in your chest, trouble breathing, gasping during sleep, dizziness, fainting, or feeling weak or tired.⁷

• Cerebrovascular events, including bleeding in the brain and stroke. Immediately call 911 if you experience severe headache, numbness or weakness in your face, arm, or leg (this may affect one side of the body), sudden confusion, trouble understanding speech or speaking, sudden difficulty walking, loss of balance, dizziness, poor coordination, or sudden sight difficulties in one or both eyes.⁸

• Other vasospasms (a narrowing of the arteries, which leads to reduced blood flow) that are not related to the heart. Types of vasospasm may include Raynaud’s syndrome. Look out for a change of color in your fingers or toes, along with feeling cold, numbness, pain, pins and needles, or trouble moving the area. Imitrex may also cause reduced blood flow to the gastrointestinal system, which can present as bloody diarrhea and stomach pain.⁹

• Medication overuse headache. Overusing Imitrex or using it for a longer period of time may have the opposite effect of treating your migraines, causing an increase in the frequency and/or severity of your headaches. Speak to your doctor if you notice this exacerbation. Detoxification (where Imitrex is discontinued safely and other alternatives are introduced to manage your current symptoms) must be performed under medical guidance.

• Serotonin syndrome: This could occur as an adverse reaction to using the injection form, particularly if you use other mental health medications, such as selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), or MAO inhibitors. Symptoms include fast heart rate, shivering, tremor, sweating, dilated pupils, uncontrolled eye movements, involuntary twitching or jerking, high body temperature, gas, diarrhea, increased alertness, agitation, muscle rigidity, seizure, and delirium. Serotonin syndrome can result in coma or death.¹⁰

• Significant increase in blood pressure and hypertensive crisis in some cases. Symptoms may include headache, dizziness, a change in mental function, shortness of breath, chest pain, reduced urination, vomiting, and vision changes.¹¹

• Anaphylactic reactions. Symptoms include a skin rash with or without itchy, swollen, red, blistered, or peeling skin, wheezing, difficulty speaking or breathing, swollen mouth, face, lips, tongue, or throat, and tightness in your chest or throat.

• Seizures. At the start of a seizure, you may see strange lights or hear sounds. Other symptoms include making a loud noise or a cry, muscle stiffness, twitching, convulsions, difficulty breathing, gasping for air, and fainting.

Overdose

Do not take more Imitrex than what your doctor recommends. Do not take two doses closer in time to each other than instructed. Doing so could lead to an overdose and potentially fatal side effects.

Symptoms of overdose may include the following:

• Tremors

• Convulsions

• Difficulty breathing and reduced breathing rate

• Redness on the skin of the arms or legs

• Bluish face and lips

• Loss of consciousness

• Paralysis

If you suspect that you or someone you know has overdosed on Imitrex, seek immediate emergency medical assistance by calling 911.

Allergy information

Allergic reactions are a potential serious side effect of Imitrex.

Stop taking Imitrex and seek emergency medical help if you develop the following symptoms:

• Skin rash with or without itchy, swollen, red, blistered, or peeling skin

• Wheezing

• Difficulty speaking or breathing

• Swollen mouth, face, lips, tongue, or throat

• Tightness in your chest or throat

If you are taking the Imitrex injection, note that some needle protectors contain latex. Tell your doctor if you are allergic to latex before taking this medication.

Long-term use of Imitrex

Imitrex is not meant for daily or long-term use. You should only take it to treat migraine headaches, not prevent them.

It is unknown whether Imitrex is safe to treat more than four headaches per month. If you have more than four headaches per month, inform your doctor before taking more of this medication.²

Taking this medication more frequently and for a long time period (for ten days or more per month), or in combination with other migraine medications, can cause medication overuse headaches. This is where the severity or frequency of your headaches worsens.

Treatment for medication overuse headache will involve following your doctor’s guidance on detoxification closely and using other medications to treat your withdrawal symptoms.

Pregnancy category

Imitrex is a pregnancy category C medication. This means the risk of using this medication during pregnancy cannot be ruled out.

Imitrex and pregnancy

Imitrex and other triptans are thought to be safe for use during pregnancy. Although human data is limited, the available studies have not shown an increased risk of adverse effects on the fetus.

However, animal research has shown that Imitrex use could be unsafe.

Imitrex is considered safer than other migraine drugs, such as dihydroergotamine and ergotamine tartrate, which are contraindicated to use during pregnancy.¹²

Imitrex and breastfeeding

This drug can pass into breast milk in low concentrations.

Ask for your doctor’s advice around taking Imitrex while breastfeeding.

Missed doses

Imitrex is not meant for daily use, so you do not need to worry about missing a dose.

Take this medication as directed by your doctor when you have a migraine headache.

This drug does not prevent headaches, so do not take this drug if you don’t have one. Doing so could result in adverse reactions or medication overuse headaches.

Drug interactions

Imitrex is known to interact with some drugs to cause a high level of serotonin in your body. This rare but serious condition is known as serotonin syndrome. Some of the medications that Imitrex interacts with include:²

• Selective serotonin reuptake inhibitors (SSRIs), like sertraline (Zoloft), citalopram (Celexa), paroxetine (Brisdelle, Pexeva, or Paxil), and fluoxetine (Prozac)

• Serotonin-norepinephrine reuptake inhibitors (SNRIs), like duloxetine (Cymbalta), venlafaxine (Effexor XR), and Desvenlafaxine (Pristiq)

• Tricyclic antidepressants (TCAs), like doxepin, nortriptyline (Pamelor), amitriptyline, and imipramine (Tofranil)

• Monoamine oxidase inhibitors (MAOIs), like tranylcypromine (Parnate), phenelzine (Nardil), isocarboxazid (Marplan), and selegiline (Emsam)

• Other triptans, like frovatriptan (Frova), eletriptan (Relpax), almotriptan (Axert), rizatriptan (Maxalt or Maxalt MLT), naratriptan (Amerge), and sumatriptan with naproxen (Treximet). Do not take these drugs within 24 hours of taking Imitrex.

• Drugs containing ergot, like ergotamine (Ergomar) or caffeine with ergotamine (Cafergot or Migergot). Do not take these drugs within 24 hours of taking Imitrex.

This list is not exhaustive. Tell your doctor about all prescription and non-prescription medicines you currently take.

Can I drink alcohol when taking Imitrex?

Drinking alcohol 30 minutes before taking Imitrex is not thought to affect how the drug works. However, you are advised to limit or avoid alcohol consumption if you suffer from migraines, as drinking alcohol can trigger or worsen migraine attacks.²

What to discuss with your doctor before starting Imitrex

Before taking Imitrex, discuss the following things with your doctor:

• Drug allergies: Tell your doctor if you are allergic to Imitrex or any other drug. Tell them if you have ever had an allergic reaction to Imitrex or another drug.

• Medications: Provide your doctor with a list of prescription and non-prescription medications, vitamins, and herbal remedies you are currently taking. Imitrex interacts with several drugs and can cause a serious condition called serotonin syndrome. Tell your doctor if you start taking any new medication while taking Imitrex.

• Medical conditions: Inform your doctor of your complete medical history. They must know if you currently have or have had high cholesterol, high blood pressure, diabetes, mental health issues, kidney or liver disease, epilepsy or seizures, heart conditions, circulation problems, or stroke. They must also know your alcohol consumption habits and whether you smoke cigarettes.²

• Pregnancy/breastfeeding: Let your doctor know if you are pregnant, planning a pregnancy, or breastfeeding.

Stopping Imitrex

Take this medicine only when you have a migraine headache or as directed by your doctor.

If you want to stop taking this drug because of minor side effects, let your doctor know about your concerns. They may suggest taking a different drug to help ease your symptoms. However, if you experience a severe reaction or serious side effect, discontinue taking this drug immediately and contact the emergency services.

Drug approval history

1992: The FDA approves Imitrex for use in the US as an injection.

1995: The oral tablet form of Imitrex is approved.

1997: Imitrex nasal spray is approved by the FDA.¹³

Tips and advice for taking Imitrex

The following tips and advice could help you take Imitrex safely and get the best results:

• Imitrex can cause drowsiness, dizziness, or weakness. Do not drive or use machinery when taking this medicine until you know how it affects you.

• Do not take more of this drug than your doctor recommends. Doing so could lead to harmful effects.

• Keep a headache diary by writing down when you have a headache and when you take Imitrex.

• Do not share your prescription with other people.

• Store Imitrex tablets, nasal spray, or injections at 36–86°F (2–30°C). Keep the medication out of direct light.

Frequently asked questions

When should I take Imitrex for migraines?

To get the best results, take Imitrex at the first sign of a migraine attack when the headache is still mild.

Remember, Imitrex won’t prevent migraine headaches or reduce the number of migraine headaches you get. The medication is used to ease migraine symptoms only.

What does Imitrex do to the body?

Imitrex eases migraine symptoms like pain and nausea by causing the blood vessels in the head to narrow. This stops pain signals from being sent to the brain. It also stops certain substances that cause migraine symptoms from being released.

How quickly does Imitrex work?

It usually takes 30–60 minutes for Imitrex tablets to work. You may experience relief 10–15 minutes after Imitrex in injection form has been administered. The nasal spray works within 15 minutes.