Migraine Patch: Sumatriptan Transdermal Patch

Overview of skin patches for migraines

First and foremost, migraines are severely painful headaches often accompanied by other symptoms such as nausea, light or sound sensitivity, and vomiting. According to JAMA Network,¹ it's estimated that more than 10% of the world's population is affected by migraines, with women accounting for a higher proportion of patients and being three times more likely to have it than men.

Fortunately, there are treatments to help reduce the symptoms and alleviate migraine pain when a pain reliever like acetaminophen or aspirin doesn't work (or cannot be taken).

One option is a skin patch for migraines. 

Skin patch drugs, also known as transdermal patches, are a common way to deliver a range of drugs, at a predetermined dose in the patch, to a patient's bloodstream through skin absorption. For example, Sumatriptan is absorbed over four hours and is often a great alternative to treatments that involve injections, oral medications, retinal applications, or nasal sprays.

Transdermal delivery for migraines can be particularly beneficial for patients suffering from gastrointestinal symptoms since gastrointestinal disorders can reduce the absorption of oral medication.

For migraine headaches, in particular, the sumatriptan transdermal patch is often prescribed.

What is a sumatriptan transdermal patch?

The sumatriptan transdermal patch, also known under the US brand name Zecuity or the generic name sumatriptan iontophoretic transdermal system, is a migraine patch used for acute migraine headache pain relief. However, it is not used as a prevention for migraine headaches but as a treatment for other types of headaches. 

The acute treatment can be used in migraine patients with or without aura (sensory disturbances like ringing in the ears or blind spots that happen shortly before migraine attacks). To be diagnosed with migraines and become eligible for a migraine patch, you must meet the International Classification of Headache Disorders II² criteria (also known as modified ICHD-2 criteria). 

How does a sumatriptan transdermal patch work for migraine?

The sumatriptan transdermal patch is a battery-operated, single-use acute treatment for migraine headaches. You take it at the onset of your migraine attack and should start feeling its effects within 2 hours after the application. This often includes some freedom from nausea.

Clinically speaking, JAMA Network³ relates that sumatriptan works by binding to serotonin receptors during a migraine episode. Essentially, this increases the amount of serotonin available for your brain. Sumatriptan targets the 5-HT (serotonin) receptors in your brain's blood vessels, narrowing them and easing symptoms and pain associated with migraine headaches. 

Factors to consider before using a sumatriptan transdermal patch

Before taking any drug for your migraines, you should always discuss the pros and cons with your healthcare professional first. This is especially true if you are or plan to become pregnant in the coming months. Consider the following factors provided by Drugs.com⁴ before using a sumatriptan transdermal patch to weigh the medicine's risks versus its benefits for your treatment, in particular. 

Allergies

Tell your doctor if you have previously experienced any reactions to sumatriptan. You should always discuss any allergies — to certain medications, animals, food, and preservatives — with your healthcare professional to avoid potentially severe side effects.

Pediatric

For clarity, the pediatric population consists of the following categories:

• Neonates — birth to 1 month

• Infants —  1 month to 2 years

• Developing children —  2 to 12 years

• Adolescents —  12 to 16 years

However, there has not been enough research carried out on the safety and effectiveness of the pediatric population using a sumatriptan patch to say for certain whether it is okay to administer. 

Geriatric

There has also not been enough research conducted on the effects of the sumatriptan patch on older age groups. However, the drug should never be used in elderly migraine patients with liver problems because it is primarily metabolized by the liver.

Furthermore, it's not recommended for elderly patients with the following age-related issues:

• High blood pressure

• Kidneys issues

• Heart disease or blood vessel disease  

Pregnancy & Breastfeeding

Very little research has been done on the effects of sumatriptan on infants during pregnancy or breastfeeding. While one study⁵ has considered it 'compatible with breastfeeding' due to such small trace amounts getting into the milk, another studies⁶ urges precaution as the research behind it is limited, providing poor quality evidence to suggest it's safe.

Instead, you are advised to take acute medications like ibuprofen, eletriptan, and diclofenac or wait until 12 hours after treatment to reduce exposure to your infant. 

Drug interactions

When taking multiple prescriptions, you must be careful about possible interactions between the different medications. While some medicines may only require a change in dosage or other alterations, others should never be combined for safety reasons. 

Before proceeding, discuss the medications you're taking and potential drug interactions with your doctor.

While using a sumatriptan transdermal patch, in particular, Drugs.com⁴ reports you should not be taking any of the following medications:

Almotriptan, Bromocriptine, Dihydroergotamine, Eletriptan, Ergoloid Mesylates, Ergonovine, Ergotamine, Frovatriptan, Furazolidone, Iproniazid, Isocarboxazid, Linezolid, Methylene Blue, Methylergonovine, Methysergide, Moclobemide, Naratriptan, Nialamide, Phenelzine, Procarbazine, Rasagiline, Rizatriptan, Safinamide, Selegiline, Tranylcypromine, and Zolmitriptan.

Moreover, they categorize the following medicines as 'usually not recommended,' but they may be in some instances:

Alfentanil, Amineptine, Amitriptyline, Amitriptylinoxide, Amoxapine, Amphetamine, Benzhydrocodone, Benzphetamine, Buprenorphine, Bupropion, Butorphanol, Citalopram, Clomipramine, Codeine, Desipramine, Desvenlafaxine, Dexfenfluramine, Dextroamphetamine, Dibenzepin, Dihydrocodeine, Dolasetron, Doxepin, Duloxetine, Escitalopram, Fenfluramine, Fentanyl, Fluoxetine, Fluvoxamine, Granisetron, Hydrocodone, Hydromorphone, Imipramine, Lasmiditan, Levomilnacipran, Levorphanol, Lisdexamfetamine, Lithium, Lofepramine, Lorcaserin, Melitracen, Meperidine, Metaxalone, Methamphetamine, Milnacipran, Mirtazapine, Morphine, Morphine Sulfate Liposome, Nalbuphine, Nefazodone, Nortriptyline, Ondansetron, Opipramol, Oxycodone, Oxymorphone, Palonosetron, Paroxetine, Pentazocine, Protriptyline, Reboxetine, Remifentanil, Sertraline, Sibutramine, St John's Wort, Sufentanil, Tapentadol, Tianeptine, Tramadol, Trazodone, Trimipramine, Venlafaxine, Vilazodone, Vortioxetine, and Ziprasidone.

Other interactions such as alcohol and tobacco

It is recommended that you do not drink alcohol or smoke tobacco while taking sumatriptan. According to one study,⁷ mood, sleep disturbances, alcohol, tobacco, and perfume can trigger a migraine. Some medications can reduce the effects of the drug in treating your migraine.

Proper use

For self-administration, RxList⁸ says the following:

• Apply the patch on your upper arm or thigh (nowhere else!).

• Never cut your patch.

• The application area should be 'dry intact, non-irritated skin' that is mostly free of hair, scarring, tattoos, or any type of skin condition. 

• Do not apply to the same site until it has been free of redness and irritation (also known as erythema) for three or more days.

Ensure you follow the precise instructions provided by your prescription and doctor when administering sumatriptan. Proper use is the key to safely and effectively using sumatriptan for migraine relief. 

Dosing

The proper dosing of the sumatriptan patch for adults is one patch applied to your skin for four hours before removal. Note that no matter how long it is on your skin, a microprocessor sets the patch to give the correct dose of sumatriptan for four hours. Nonetheless, the patch should be removed after four hours. 

Warning

Don't administer the drug more than twice in 24 hours or within two hours of the first active treatment. Taking too much sumatriptan can cause problematic sleepiness, vomiting, slowed heart rate, and loss of bowel control.

What happens if I miss a dose?

Sumatriptan is an active treatment only applied at the onset of migraine attacks and migraine-related nausea, sensitivity, and vomiting. For this reason, there is no such thing as 'missing a dose.' You only take it as needed. 

What happens if I overdose?

Like with most other drugs, overdosing on sumatriptan is very dangerous! Too much sumatriptan can lead to symptoms such as:

• Drug-induced headache

• Fainting

• Slowed heart rate

• Chest pain

• Heart attack

• Abnormal heart rhythm

• Sleepiness

• Loss of bowel control

If you suspect or show signs of an overdose, seek emergency medical attention immediately.

Side effects of using sumatriptan transdermal patch for migraine

First and foremost, side effects can differ from patient to patient, so you must discuss any potential reactions or symptoms with your doctor. 

Most common

Some of the most common side effects of sumatriptan include:

• Warm or cold feelings

• Feeling drowsy or dizzy 

• Weakness

• Upset stomach

• Muscle cramps

• Diarrhea

• Nausea

• Triptan-related side effects (also known as 'triptan sensations') — tingling, flushing, neck pain, mild transient chest pressure, and paraesthesias 

Less common

Although more serious, the following symptoms are less common side effects:

• Speech difficulties

• Faintness

• Cold sweats

• Shortness of breath or difficulty breathing and swallowing

• Numbness in the arm or leg

• Severe stomach pain

• Fast or irregular heartbeat

• Bloody diarrhea

• Vomiting

• Sudden weight loss

• Paleness or blue fingers and toes

• Redness, swelling, or itching of the eyes, face, lips, or throat

• Rashes

• Hives

• Vision changes

• Seizures

In more rare cases, triptan-related side effects may also include cardiovascular complications such as cardiac arrhythmias, myocardial infarction, and stroke. 

If you experience one or more of these side effects, consult your doctor immediately. 

Incidence not known

It is possible to experience a side effect or symptom related to sumatriptan that is not yet known or listed. Always discuss your experience with sumatriptan in full with your doctor for the sake of your safety, health, and overall well-being. 

Precautions when using sumatriptan for migraines

Sumatriptan has been an effective treatment for many migraine patients. As with any drug, you must be careful when using sumatriptan for migraines. Be sure to consider the following precautions.  

Allergic contact dermatitis

Consult your doctor after your first use of the sumatriptan patch if you develop allergic contact dermatitis — a rash or irritation caused by contact with certain substances. This may signify that you are allergic to sumatriptan and require an alternative treatment. 

Medical history

Taking sumatriptan for migraine attacks can be beneficial for many patients. However, some histories of medical problems can make taking sumatriptan dangerous. For instance, you should talk to your doctor before using migraine medication if you have or ever had:

• Vascular diseases or conditions — peripheral vascular ischemia, unmanaged high blood pressure, ischemic bowel disease, or any other vascular issues 

• Heart problems — heart disease, coronary artery disease, irregular heart rhythms, Wolff-Parkinson-White syndrome, or any other heart problems 

The lowdown

There are currently no FDA-approved transdermal patches for use in treating migraines. If you are still using transdermal patches, contact your doctor and:

• Consider important factors that relate to you before starting the treatment 

• Do not exceed the recommended dose of sumatriptan 

• Educate yourself on side effects and monitor their development throughout the treatment

• Discuss the precautions of headache management with sumatriptan with your doctor

If adverse effects occur on the patch site application or as a result of the drug, there are alternatives you can consider.

Other types of treatment for acute migraine attacks include pain medication in the form of an oral pill (if you don't have poor oral absorption), nasal delivery systems, injections, or rectal (given there are no bowel absorption issues).

Always discuss the different types of administration of medications and your preferred application with your physician to ensure you're getting the best migraine treatment for you. Your healthcare professional will be able to work closely with you to ensure your treatment is safe, effective, and as comfortable as possible.