sumatriptan oral spray (ALA-001) / Arovella Therap, Strides Pharma Science - LARVOL DELTA

Onset of Transient Sadness Following the Concomitant Use of a Triptan and Selective Serotonin Reuptake Inhibitor/Serotonin Norepinephrine Reuptake Inhibitors Therapy: A Case Report. (PubMed, J Pharm Pract) - "Case Presentation: We present a case of a 39-year-old female with a history of migraine with aura and depression who had brief episodes of exacerbated depressive symptoms following oral administration of sumatriptan 100 mg daily as needed while taking various selective serotonin reuptake inhibitor (SSRI) and serotonin and norepinephrine reuptake inhibitor (SNRI) medications on different occasions. Current evidence and known pharmacological actions of SSRIs/SNRIs and triptans are not well-defined enough to explain how one can experience episodic worsening depression. This case illustrates that clinicians should consider other potential adverse effects of the combined use of triptans and SSRIs/SNRIs beyond serotonin syndrome."

Clinical • Journal • CNS Disorders • Depression • Migraine • Psychiatry

Evaluation of sex differences in the pharmacokinetics of oral sumatriptan in healthy Korean subjects using population pharmacokinetic modeling. (PubMed, Biopharm Drug Dispos) - "Our results showed that there were sex differences in the clearance of oral sumatriptan. These results encourage further studies to establish the sumatriptan pharmacokinetic-pharmacodynamic (PK-PD) model considering sex-related PK differences, which may help to determine optimal dosing regimens for effective treatment of migraine in males and females."

Clinical • Journal • PK/PD data • CNS Disorders • Migraine

Atogepant and sumatriptan: no clinically relevant drug-drug interactions in a randomized, open-label, crossover trial. (PubMed, Pain Manag) - "Sumatriptan GMRs for AUC, AUC and C versus with atogepant were within 90% CI 0.80-1.25. Atogepant with sumatriptan had no clinically relevant pharmacokinetic interactions."

Clinical • Journal • CNS Disorders • Migraine

Naratriptan is as effective as sumatriptan for the treatment of migraine attacks when used properly. A mini-review. (PubMed, Cephalalgia) - "Naratriptan was marketed for the treatment of migraine attacks as the "gentle triptan" in a low oral dose of 2.5 mg, a dose with no more adverse events than placebo. This low dose results in the slow onset of action and low efficacy of oral naratriptan, but in high doses oral naratriptan is similar to oral sumatriptan. Based on one randomized controlled trial, subcutaneous naratriptan has probably the greatest effect of any triptan."

Journal • Review • CNS Disorders • Migraine • Pain

[VIRTUAL] Off-label use of CGRP monoclonal antibodies in patients with chronic cluster headache (EAN 2021) - " Two male patients (30 and 38 years old) with chronic cluster headache, both using 960mg of Verapamil with mild effect, were consulted in a headache clinic...The patients were prescribed monthly injections of Erenumab 140mg and Fremanezumab 225mg, respectively, considering their efficacy, safety and expected trials in cluster headache patients (medication choice was based on the patients’ economic preferences)...The second patient had four injections and reports 0-1 attack per day, lasting no more than 60 minutes, which can be aborted by oral sumatriptan. CGRP monoclonal antibodies may be effective in patients with chronic cluster headache. However, clinical trials are needed to prove efficacy on a large group of patients."

Clinical • Chronic Cluster Headache • Migraine • Pain

[VIRTUAL] Refractory migraine treatment during pregnancy: A case report (AHS 2021) - "At approximately 19weeks gestation, she reported 7days of continuous throbbing headache that was refractory to multiple treatments including prophylactic cyproheptadine and abortive therapies such as oral sumatriptan 50100mg, acetaminophen 500mg as well as a 5-day course of prednisone 20mg twice daily...Headache freedom was achieved after three months of a multidisciplinary treatment approach consisting of bimonthly physician visits, botulinum toxin injections, monthly ONB/TPIs, daily Propranolol 60 mg ER and Magnesium Oxide 400 mg and physical therapy... Our findings suggest that it is reasonable to treat pregnant women, especially those who are refractory and have undergone IVF-ET, with a comprehensive, collaborative and multidisciplinary approach. There are limitations to treatment options due to safety concerns during pregnancy. Thorough coordination, including an inclusive discussion of risk and benefits with both the patient and the obstetrician is recommended."

Clinical • CNS Disorders • Migraine • Musculoskeletal Pain • Pain

[VIRTUAL] Preference for rimegepant and improved clinical global impression of change among adults with a history of triptan treatment failure: Results from a long-term open-label safety study (AHS 2021) - P2/3 | "The most commonly failed triptans in both subgroups were oral sumatriptan followed by oral rizatriptan. Over 52 weeks of acute treatment with oral rimegepant, more than 75% of subjects with a history of triptan treatment failure preferred rimegepant to prior acute treatments for migraine and 9 in 10 subjects experienced clinical improvement."

Clinical • CNS Disorders • Migraine

[VIRTUAL] Estimated migraine acute-therapy savings, from MMD reduction achieved with preventive treatment (AAN 2021) - " Generic oral sumatriptan succinate (SS) and rizatriptan benzoate (RB) accounted for ~90% of prescriptions (73.4% and 17.8% in Medicaid, and 71.5% and 19.0% in Medicare, respectively). Non-oral and/or branded triptans accounted for ~5% (Medicaid: 3.1% subcutaneous SS and 1.5% nasal sumatriptan; Medicare: 2.0% branded oral eletriptan and 1.6% nasal sumatriptan)... In migraineurs with high MMDs, reduced use of non-oral/branded triptans resulting from preventive treatment may yield large savings."

CNS Disorders • Migraine

Fabrication of polyvinyl alcohol based fast dissolving oral strips of sumatriptan succinate and metoclopramide HCL. (PubMed, Sci Prog) - "Dissolution studies were carried out in distilled water for 15 min and all the formulations have shown released more than 50% drug within first 2 min thereby highlighting the usefulness of FDOSs for the delivery of both drugs in combination significantly. Optimized combination of ingredients was found to be suitable for the formulation of FDOSs for simultaneous delivery of Metoclopramide HCl and Sumatriptan succinate."

Journal • CNS Disorders • Migraine

Sumatriptan alleviates radiation-induced oral mucositis in rats by inhibition of NF-kB and ERK activation, prevention of TNF-α and ROS release. (PubMed, Arch Oral Biol) - "Based on study results, sumatriptan mitigate radiation-induced oral mucositis by inhibiting NF-kB, ERK and limiting the release of TNF-α, oxidative stress factor and apoptosis."

Journal • Preclinical • CNS Disorders • Head and Neck Cancer • Immunology • Inflammation • Migraine • Mucositis • Oncology • Pain • Solid Tumor • Stomatitis • NFKB1 • TNFA

Vasospasm induced myocardial ischaemia secondary to sumatriptan use. (PubMed, BMJ Case Rep) - "Most cases thus far have been reported in patients using the subcutaneous preparation of sumatriptan. Here, we present a case of a patient without prior risk factors for CAD and angiographically unremarkable coronary arteries who presented with evidence of an AMI after oral sumatriptan use for migraines."

Journal • Cardiovascular • CNS Disorders • Coronary Artery Disease • Heart Failure • Migraine • Myocardial Infarction • Pain

Chronic Cluster Headache with a Pediatric Onset: The First Japanese Case Report. (PubMed, Intern Med) - "A combination of low-dose verapamil and lomerizine once a week decreased the frequency of the attacks, and oral sumatriptan became an effective abortive therapy. No case reports of pediatric CCH have been previously published in Japan."

Clinical • Journal • Chronic Cluster Headache • CNS Disorders • Pain • Pediatrics

Evaluating Mean Level and Within-Person Consistency in Migraine Pain Intensity and Migraine-Related Disability for AVP-825 vs Oral Sumatriptan: Results from the COMPASS Study, A Randomized Trial. (PubMed, Headache) - P3 | "LSMEMs demonstrate that treatment with AVP-825 is associated with lower average migraine pain intensity and disability from 10 to 90 minutes and greater within-person consistency across multiple migraine attacks (reduced WPV) from 45 to 120 minutes post-dose compared to oral sumatriptan. These findings may reflect the more rapid and consistent absorption of sumatriptan using AVP-825. Increased WPV with AVP-825 in the first 15 minutes likely reflects the earlier onset of treatment effects with the device compared to oral sumatriptan. LSMEMs show promise as a novel approach for assessing and comparing consistency of treatment response in migraine trials."

Clinical • Journal • CNS Disorders • Migraine • Pain

[VIRTUAL] Ubrogepant Does Not Induce Latent Sensitization in a Preclinical Model of Medication Overuse Headache (AHS 2020) - "Female, Sprague Dawley rats were primed with oral sumatriptan over 2 weeks to induce latent sensitization, which is manifested as cutaneous allodynia (CA) following challenge with psychological stress induced by bright lights (bright light stress, BLS) or by administration of sodium nitroprusside, a nitric oxide (NO) donor. Both ubrogepant and sumatriptan demonstrated efficacy as acute medications for stress- and NO donor-induced CA in a preclinical model of MOH, consistent with their clinical efficacy in the acute treatment of migraine. However, unlike sumatriptan, repeated treatment with ubrogepant did not induce CA or latent sensitization. These studies suggest that ubrogepant may offer an effective acute treatment option for migraine without risk of MOH."

Preclinical • CNS Disorders • Migraine

Practice guideline update summary: Acute treatment of migraine in children and adolescents: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Headache Society. (PubMed, Headache) - "Recommendations for the treatment of acute migraine in children and adolescents focus on the importance of early treatment, choosing the route of administration best suited to the characteristics of the individual migraine attack, and providing counselling on lifestyle factors that can exacerbate migraine, including trigger avoidance and medication overuse."

Clinical • Journal • CNS Disorders • Migraine • Pain

Ubrogepant does not induce latent sensitization in a preclinical model of medication overuse headache. (PubMed, Cephalalgia) - "Both ubrogepant and sumatriptan demonstrated efficacy as acute medications for stress- and nitric oxide donor-evoked cephalic allodynia in a preclinical model of medication overuse headache, consistent with their clinical efficacy in the acute treatment of migraine. However, in contrast to sumatriptan, repeated treatment with ubrogepant did not induce cutaneous allodynia or latent sensitization. These studies suggest ubrogepant may offer an effective acute treatment of migraine without risk of medication overuse headache. Trial Registration Number: Not applicable."

Journal • Preclinical • CNS Disorders • Migraine • Pain

Evaluation of LY573144 (lasmiditan) in a preclinical model of medication overuse headache. (PubMed, Cephalalgia) - "In a pre-clinical rat model of MOH, oral lasmiditan, like sumatriptan, induced acute transient cutaneous allodynia in the periorbital and hindpaw regions that after resolution could be re-evoked by putative migraine triggers. These results suggest that lasmiditan has the capacity to induce MOH through persistent latent peripheral and central sensitization mechanisms."

Journal • Preclinical • CNS Disorders • Migraine • Pain

[VIRTUAL] COST-UTILITY ANALYSIS OF ORAL SUMATRIPTAN/NAPROXEN VERSUS ORAL SUMATRIPTAN FOR THE TREATMENT OF ACUTE MIGRAINES (ISPOR 2020) - "CONCLUSIONS Using the accepted ICER threshold of $150,000 per QALY gained, the use of sumatriptan/naproxen does not provide good value. Using each drug as a separately may provide greater dosing flexibility at a lower cost."

HEOR • CNS Disorders • Migraine

Cluster-status migrainosus with a weekly periodicity responsive to high-flow oxygen: A case report. (PubMed, Cephalalgia) - "These headaches did not respond to trials of propanolol, sodium valproate, topiramate, amitriptyline, gabapentin, and carbamazepine for preventive treatment or to oral sumatriptan and butalbital-acetaminophen-caffeine for acute treatment. Conclusion We believe this is the first case of "cluster-status migranosus" described in the medical literature. High-flow oxygen both aborted the cluster headaches and prevented the ensuing status migrainosus."

Clinical • Journal

Efficacy of Ubrogepant in a Preclinical Model of Medication Overuse Headache (AAN 2020) - "Male or female Sprague-Dawley rats received 6 oral administrations of sumatriptan over 10 days and cephalic and hindpaw allodynia was repeatedly evaluated. This study demonstrates that ubrogepant, a small-molecule CGRP antagonist, shows similar efficacy as sumatriptan in a preclinical model of MOH consistent with the causal relationship of CGRP to migraine pain."

Preclinical

Practice guideline update summary: Acute treatment of migraine in children and adolescents: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Headache Society. (PubMed, Neurology) - "Recommendations for the treatment of acute migraine in children and adolescents focus on the importance of early treatment, choosing the route of administration best suited to the characteristics of the individual migraine attack, and providing counseling on lifestyle factors that can exacerbate migraine, including trigger avoidance and medication overuse."

Clinical • Journal

PARACENTRAL ACUTE MIDDLE MACULOPATHY FOLLOWING ORAL INTAKE OF SUMATRIPTAN. (PubMed, Retin Cases Brief Rep) - "Sumatriptan may be a trigger for paracentral acute middle maculopathy."

Journal

From investigational product to active reference: evolution of oral sumatriptan efficacy versus placebo for the treatment of acute migraine episodes and potential impact in comparative analyses. (PubMed, J Mark Access Health Policy) - " The relative effect of sumatriptan evolved substantially over time. This phenomenon may impact the results of network meta-analysis and indirect comparisons performed to evaluate the potential of a new drug, compared to widely prescribed older drugs."

Clinical • Journal