💊 Sumatriptan (Tosymra)
Sumatriptan nasal spray is used for the acute treatment of migraine with or without aura in adults. It is not for migraine prevention or cluster headache. It should only be used once a clear diagnosis of migraine has been established by a doctor.
In Arabic: سوماتريبتان (بخاخ أنفي - توسيمرا)
🏷️ Brand names & manufacturers
Packages shown are US-market (DailyMed). Brands available in Palestine are in the price section below.
Tosymra🏭 Upsher-Smith Laboratories, LLC
Sumatriptan🏭 Caplin Steriles Limited
Sumatriptan🏭 Strides Pharma Science Limited✅ What it is used for
- Acute treatment of migraine with or without aura in adults
🧪 Active ingredient
Sumatriptan binds to 5-HT1B/1D receptors on intracranial blood vessels and trigeminal sensory nerves, causing cranial vessel constriction and inhibition of pro-inflammatory neuropeptide release.
🌿 Benefits
- Relief of acute migraine attacks
- Relatively rapid absorption (median time to peak about 10 minutes)
📝 How to use
- The dose and method of use are set by your doctor or pharmacist; do not change them without consulting them
- The spray is given as a single spray in one nostril
- Do not test the device before use
- Follow the Patient Information and Instructions for Use leaflet in the carton
💊 Dosage forms
- Single-dose nasal spray device delivering 10 mg of sumatriptan
- Each carton contains 6 single-use units
⚠️ Common side effects
- Tingling
- Dizziness/vertigo
- Warm/hot sensation
- Burning sensation
- Feeling of heaviness, pressure, or tightness
- Flushing
- Numbness
- Application site reactions in the nose
- Altered taste (dysgeusia)
- Throat irritation
🚨 Serious — seek medical help
- Chest pain/tightness possibly related to myocardial ischemia, myocardial infarction, or coronary vasospasm
- Arrhythmias
- Stroke or cerebral hemorrhage
- Gastrointestinal ischemia and peripheral vasospastic reactions
- Serotonin syndrome
- Increase in blood pressure, including hypertensive crisis
- Hypersensitivity reactions such as angioedema and anaphylaxis
- Seizures
- Medication overuse headache
⛔ Do not use if
- Ischemic coronary artery disease or coronary vasospasm, including Prinzmetal's angina
- Wolff-Parkinson-White syndrome or arrhythmias associated with other cardiac accessory conduction pathway disorders
- History of stroke, transient ischemic attack, or hemiplegic or basilar migraine
- Peripheral vascular disease
- Ischemic bowel disease
- Uncontrolled hypertension
- Use of ergotamine-containing or ergot-type medications or another 5-HT1 agonist within 24 hours
- Concurrent or recent (within 2 weeks) use of an MAO-A inhibitor
- Hypersensitivity to sumatriptan
- Severe hepatic impairment
❗ Warnings & precautions
- A cardiovascular evaluation is advised before use in triptan-naive patients with multiple cardiovascular risk factors (older age, diabetes, hypertension, smoking, obesity, strong family history of CAD)
- Stop the drug and seek medical help if arrhythmia, stroke symptoms, allergic reaction, or serotonin syndrome occurs
- Chest, throat, neck, or jaw pain/tightness/pressure can occur and is generally not associated with myocardial ischemia, but high-risk patients should be evaluated
- Use with caution in patients with epilepsy or a lowered seizure threshold
- Detoxification may be necessary for medication overuse headache
- Use only if a clear diagnosis of migraine has been established; if there is no response to the first attack treated, reconsider the diagnosis
🔄 Drug interactions
- Ergotamine-containing or ergot-type drugs (e.g., dihydroergotamine, methysergide): contraindicated within 24 hours of each other
- MAO-A inhibitors: contraindicated because they increase systemic exposure 2-fold
- Other 5-HT1 agonists (triptans): contraindicated within 24 hours of each other
- SSRIs, SNRIs, tricyclic antidepressants and MAO inhibitors: risk of serotonin syndrome
🤰 Pregnancy
A pregnancy registry and epidemiological studies have not detected an increased frequency of birth defects or a consistent pattern of defects. In animal studies, sumatriptan was associated with embryo lethality, fetal abnormalities, and pup mortality. Consult your doctor before use during pregnancy.
🍼 Breastfeeding
The provided label text does not include information on breastfeeding; consult your doctor or pharmacist.
🧒 Children
Safety and effectiveness in pediatric patients have not been established and use is not recommended under 18 years. Trials of sumatriptan nasal spray and oral tablets in adolescents 12 to 17 years did not establish efficacy, and post-marketing reports include serious reactions such as stroke, visual loss, and death.
👴 Older adults
Trials did not include enough patients aged 65 and over to determine differences in response. Dose selection should be cautious, usually starting at the low end of the range, because of more frequent decreased hepatic, renal, or cardiac function. A cardiovascular evaluation is recommended if other risk factors are present.
🌡️ Storage
Store at 20° to 25°C (68° to 77°F); excursions permitted between 15° and 30°C. Do not store in the refrigerator or freezer. Do not test before use.
⏰ Missed dose
This medicine is used as needed to treat a migraine attack, not on a regular schedule, so there is no missed dose. Ask your doctor how to use it.
🆘 Overdose
Animal data suggest overdose may cause convulsions, tremor, inactivity, erythema of the extremities, reduced respiratory rate, cyanosis, ataxia, mydriasis, and paralysis. Monitor patients for at least 10 hours or while symptoms persist. Seek emergency medical help immediately.
💰 Price & brands in your area
🏛️ Official price in Palestine — Ministry of Health price list:
| Product | Company | Pack | Price |
|---|---|---|---|
| SUMATRIDEX 100 MG 6 CAP Sumatriptan as succinate | Alram Drug Store | 6 caps | 45 ₪ |
| Migratan 100 mg Tab Sumatriptan as succinate 100mg/tab. | Beit Jala | 6 caplet | 48 ₪ |
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Mechanism of action
High-affinity agonist at human 5-HT1B/1D receptors; therapeutic effect in migraine is presumed to result from agonism at receptors on intracranial blood vessels and trigeminal sensory nerves, causing cranial vessel constriction and inhibition of pro-inflammatory neuropeptide release. Relative bioavailability of the nasal spray is about 87% versus 4 mg subcutaneous and about 58% versus 6 mg subcutaneous. Median Tmax is about 10 minutes (range 5-23), protein binding is low (14-21%), and elimination half-life is about 2 hours.
Labeled dosing
Adults: 10 mg as a single spray in one nostril. Maximum cumulative dose is 30 mg in 24 hours, with doses separated by at least 1 hour. May be given at least 1 hour after a dose of another sumatriptan product. The final dose is determined by the prescriber.
- After overdose, monitor for at least 10 hours; the effect of hemodialysis or peritoneal dialysis on serum concentration is unknown
- In patients with multiple cardiovascular risk factors and a negative evaluation, consider giving the first dose in a medically supervised setting with an ECG afterward
- In a 6-month open-label study, local irritative symptoms were reported in about 46% of patients
- If there is no response to the first attack treated, reconsider the diagnosis before treating subsequent attacks
🎓 Key points for students
- Class: 5-HT1B/1D receptor agonist (triptan)
- Indication: acute migraine treatment only, not prevention or cluster headache
- Dose: 10 mg intranasal; maximum 30 mg/24 h, doses at least 1 hour apart
- Key contraindications: CAD, stroke/TIA, uncontrolled hypertension, MAO-A inhibitors, ergot or other triptans within 24 hours, severe hepatic impairment
- Serotonin syndrome risk with SSRIs, SNRIs, and tricyclic antidepressants
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What is sumatriptan nasal spray used for?
It is used for the acute treatment of migraine with or without aura in adults, not for prevention or cluster headache.
What is the maximum daily dose?
According to the label, the maximum is 30 mg in 24 hours with doses at least 1 hour apart, but your doctor or pharmacist sets your actual dose.
What are the common side effects?
Tingling, dizziness, warm or burning sensations, heaviness, pressure, numbness, plus nasal application site reactions, altered taste, and throat irritation.
Can it be used with other migraine medicines?
Not with ergot drugs or another triptan within 24 hours, and not with MAO-A inhibitors. Ask your doctor before combining with any medicine.
Can children use it?
No. Safety and effectiveness have not been established and it is not recommended under 18 years.
When should I seek urgent medical help?
For severe chest pain or pressure, stroke symptoms, swelling of the face or throat with trouble breathing, or signs of serotonin syndrome.
⚕️ For education only — not a substitute for advice from your doctor or pharmacist. Do not start or stop any medicine without advice. Source: official FDA drug label via openFDA (2024-11), simplified. Updated: 2026-11-11.