NEWLY DISCOVERED USES (OFF-LABEL)
Lumbar puncture induced headache, migraine treatment in children
ORIGINAL USES (ON-LABEL)
Acute treatment of migraine with or without aura, acute treatment of cluster headaches (injectable)
BRAND NAME Imitrex
DRUG CLASS
Antimigraine (serotonin 5-HT4 receptor agonist)
DESCRIPTION
Stimulates serotonin receptors in the cranial arteries which causes constriction of blood vessels and a relief of migraine symptoms.
POTENTIAL SIDE EFFECTS
Injection: Blood pressure increases, chest pain, sensation of unusual heart beats, dizziness, drowsiness, fatigue, skin flushing, mild increases in growth hormone, hot flashes, nausea, abdominal pain, dry mouth, shortness of breath.
Nasal Spray: bad taste, nausea, vomiting, dizziness, nasal discomfort.
Tablets: chest pain/tightness/heaviness/pressure, neck, throat and jaw pain/tightness/pressure, numbness.
CAUTIONS
Only for patients with clear diagnosis of migraine. Not for preventive treatment of migraine headaches.
Notify your doctor of cardiac problems, particularly chest pain, irregular heart rhythm, uncontrolled blood pressure. Also notify your doctor if you have basilar or hemiplegic migraine.
First dose may be given in healthcare setting.
May make you drowsy and affect your judgment. Be careful when driving a car or operating machinery.
Patients should be monitored for blood pressure changes.
Alcohol may have added central nervous toxicity.
Cerebral bleeding, stroke or other brain vascular events have been reported with this drug class.
Cardiac events and stroke have been reported with 5-HT1 agonist use.
Do not use during or within 2 weeks of MAO inhibitors, or within 24 hours of treatment with another 5-HT1 agonist, or ergot-containing or ergot-like medication.
Use with caution in patients that are elderly, with liver or kidney impairment.
Do not use in patients with signs and symptoms of reduced arterial flow (ischemic bowel, Raynaud’s) which could be exacerbated by vasospasm.
Reconsider diagnosis of migraine if no response to initial dose.
DRUG INTERACTIONS
5-HT1 agonists, ergot-containing drugs (dihydroergotamine, methysergide), propranolol, selective serotonin reuptake inhibitors (fluoxetine, fluvoxamine, paroxetine, sertraline), MAO inhibitors, nonselective MAO inhibitors, sibutramine
FOOD INTERACTIONS
Take without regard to meals.
HERBAL INTERACTIONS
Unknown
PREGNANCY AND BREAST-FEEDING CAUTIONS
FDA Pregnancy Risk Category C. Excreted in breast milk. Consult your doctor.
SPECIAL INFORMATION
Injectable product requires education. May use second dose of nasal spray within two hours after first dose. However, do not use second nasal spray without consulting doctor. Do not use more than 40 mg of nasal spray in any 24-hour period. Redosing
should be separated by at least two hours. No more than 200 (oral) mg used in any 24-hour period. Patients taking propranolol should take a reduced dose.
