Sumatriptan: pharmacological basis and clinical results

Sumatriiptan was the first selective serotonin (5-HT)1B/1D agonist for the acute treatment of migraine attacks. Apart from the subcutaneous and oral formulation, it is also available as nasal spray and suppository. In placebo-controlled clinical trials, sumatriptan, administered subcutaneously, orally, intranasally or rectally was significantly more effective than placebo in relieving migraine headache and in producing relief or resolution of other symptoms associated with migraine, including nausea, photophobia and phonophobia. For patients who desire particularly rapid relief that cannot be provided by a tablet form, sumatriptan injection with a 10-minute onset of action may be an appropriate choice. Patients with very severe attacks and those with vomiting may also benefit from the injection. For patients with nausea who do not wish to take tablets or who fear injections, a sumatriptan nasal spray or a suppository may be appropriate options. New triptans, zolmitriptan, rizatriptan, and naratriptan began entering the market in 1997 but in clinical practice, in particular after dose adjustments have been made, all triptans appear to be very similar with respect to efficacy and tolerability as well as safety.