
Sumatriptan is a drug used to treat migraines and cluster headaches. It is a vasoconstrictor, meaning it narrows the blood vessels in the brain. While this can help alleviate migraine symptoms, there are concerns that it may increase the risk of stroke.
Some studies have found a link between triptan usage and stroke risk, particularly in women and younger patients. However, it is unclear whether the increased risk is due to the drug itself or the underlying migraine condition. Sumatriptan is contraindicated for those with a history of stroke or transient ischaemic attacks.
While the evidence is mixed, it is important to carefully consider the benefits and risks before prescribing sumatriptan, especially in patients with stroke risk factors.
Characteristics | Values |
---|---|
Sumatriptan's risk of causing strokes | Sumatriptan is associated with an increased risk of ischemic and hemorrhagic strokes, especially in women under 45. However, the overall risk is low, and the strokes are typically minor. |
Risk factors | Risk factors include younger age, female sex, smoking, oral contraceptive use, and migraine with aura. |
Precautions | Sumatriptan is contraindicated in patients with a history of stroke, transient ischemic attacks, or those over 65 years old. |
What You'll Learn
- Sumatriptan is contraindicated for patients with a history of strokes or TIAs
- Sumatriptan is not recommended for patients over 65
- Sumatriptan may be prescribed to those over 65 if the benefits outweigh the risks
- Sumatriptan may cause prolonged binding to cerebral vascular receptors
- Sumatriptan is unlikely to increase the risk of cerebrovascular events if contraindications are observed
Sumatriptan is contraindicated for patients with a history of strokes or TIAs
Sumatriptan is contraindicated for patients with a history of strokes or transient ischaemic attacks (TIAs). This is because sumatriptan is used for the acute treatment of migraines and cluster headaches and appears to work by constricting the cranial blood vessels. In patients with a history of strokes or TIAs, this action could potentially lead to another stroke.
In a study of 14,964 patients, a small but significant number of cerebrovascular events were identified at a rate of 1 per 1,000 patients. There were 15 reports of cerebrovascular events, including one fatality, severe stroke with permanent disability, and temporary dysphasia. Several of these events occurred in patients with known risk factors and were therefore potentially preventable.
In another study, migraineurs identified by triptan utilisation were found to be at higher risk for stroke. However, the risk was not related to the use of triptans but rather the underlying migraine disease. Strokes in migraineurs are minor and less often associated with classical stroke risk factors.
A further study found that migraine-related stroke refers to any stroke that occurs in migraineurs, and its incidence rate ranges from 1.44/100,000 to 1.7/100,000 persons per year. The study also found that migraine is an indirect or associated contributor to stroke, with a relative risk of 2.0.
Therefore, while sumatriptan is contraindicated for patients with a history of strokes or TIAs, the risk of stroke appears to be related to the underlying migraine disease rather than the use of triptans.
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Sumatriptan is not recommended for patients over 65
Sumatriptan is a drug used to treat migraine attacks. It is not recommended for patients over 65 due to an increased risk of adverse side effects in elderly patients. Sumatriptan is a selective serotonin (5-hydroxytryptamine-1d) receptor agonist, which causes vasoconstriction of the arterioles and arteriovenous anastomata of the carotid vascular bed. This mechanism is thought to underlie the anti-migraine effect of sumatriptan. However, this mechanism also increases the risk of serious vascular events, such as myocardial infarction, stroke, and ischemic colitis, especially in patients with cardiovascular disease or risk factors.
The use of sumatriptan in patients over 65 is quite common, but it is not recommended according to the summary of product characteristics as safety and efficacy have not been established in this age group. Prescription in older patients is contraindicated in cases of past history of ischemic cardiovascular conditions (myocardial infarction, coronary vasospasm), peripheral arterial pathology, arterial hypertension, or stroke. The risk of vascular events associated with sumatriptan use is further elevated in elderly patients due to age-related physiological changes and comorbidities.
A study by Tran et al. (2024) found that triptan use among older patients may be associated with a low increased risk of acute vascular events, with a more marked risk for cerebral events such as stroke than for cardiac events. The study included 24,774 triptan users and 99,096 propensity-matched controls aged 65 and above. Within 90 days after the start of triptan treatment, 163 vascular events were observed in the triptan group (0.66%) and 523 in the control group (0.53%). The adjusted hazard ratio for triptan exposure was 1.25 (95% CI 1.05-1.49). The risk was more pronounced for cerebral events, with an adjusted odds ratio of 2.14 (95% CI 1.26-3.63).
Another study by Hall et al. (2004) found no association between triptan prescription and stroke in a cohort of 63,575 migraine patients, of whom 13,664 were prescribed triptans. However, the larger group of migraine patients not prescribed triptans had an increased risk of stroke (HR 1.51, 95% CI 1.26-1.82). This suggests that triptan treatment may not directly cause stroke, but rather that the underlying migraine disease increases stroke risk.
Sumatriptan is generally not recommended for patients over 65 due to the potential risk of serious vascular events, including stroke. However, the available evidence is limited and more research is needed to fully understand the risks associated with sumatriptan use in elderly patients.
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Sumatriptan may be prescribed to those over 65 if the benefits outweigh the risks
Sumatriptan is a drug used to treat migraine attacks with or without aura. It is a selective serotonin (5-hydroxytryptamine-1d) receptor agonist and works by narrowing blood vessels, which eases the pain. It also blocks nerve signals that cause symptoms like nausea and sensitivity to light and sound. It is available in the form of a liquid that is injected under the skin, a nasal powder, a nasal spray, and a tablet that is swallowed.
Sumatriptan should be used with caution in patients with a history of seizures or other risk factors that lower the seizure threshold, as seizures have been reported in association with the drug. It should also be used with caution in patients with mild controlled hypertension, as transient increases in blood pressure and peripheral vascular resistance have been observed in a small proportion of patients. Sumatriptan may also increase the risk of a heart attack or stroke that can lead to death.
Sumatriptan is contraindicated for people with severe hepatic impairment, moderate and severe hypertension, and mild uncontrolled hypertension. It is also contraindicated for people with a history of cerebrovascular accident (CVA) or transient ischaemic attack (TIA).
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Sumatriptan may cause prolonged binding to cerebral vascular receptors
Sumatriptan is a serotonin receptor agonist used to treat migraines and cluster headaches. It is administered orally, subcutaneously, intranasally, or rectally and is effective in providing pain relief when taken immediately after the onset of migraine symptoms. Sumatriptan acts as an agonist on 5-HT1B/1D receptors by inducing vasoconstriction in the basilar artery and blood vessels within the dura mater.
Sumatriptan has been associated with an increased risk of stroke, particularly in women aged 25-45 years. While the exact mechanism is not fully understood, it is suggested that multiple doses of sumatriptan may cause prolonged binding to cerebral vascular receptors, leading to vasoconstriction and reduced blood flow in the brain. This prolonged binding may be more likely to occur in patients with underlying migraine disease and those with certain risk factors, such as cardiovascular risk factors.
The possibility of prolonged binding to cerebral vascular receptors highlights the importance of careful risk assessment before prescribing sumatriptan, especially in patients with a history of cerebrovascular disease or other pre-existing conditions. It is crucial to follow the recommended dosage guidelines and not exceed the maximum dose to minimize the potential risk of adverse events.
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Sumatriptan is unlikely to increase the risk of cerebrovascular events if contraindications are observed
Sumatriptan is a drug used to treat migraines and cluster headaches. It is available in oral and subcutaneous forms and acts by constricting the cranial blood vessels. Sumatriptan is contraindicated for patients with a history of transient ischaemic attacks or strokes.
A study monitoring Sumatriptan in a cohort of almost 15,000 patients identified cerebrovascular events at a rate of 1 per 1,000 patients. However, the majority of these patients had a long history of migraine without hemiplegia or aphasia, and the cerebrovascular events developed only after the use of Sumatriptan. When the contraindications and precautions for dose, age and pre-existing conditions are observed, Sumatriptan is unlikely to increase the risk of cerebrovascular events.
A separate study found that the risk of ischemic stroke in patients with migraine was twice that of the general population. However, this increased risk was not related to the use of triptans, but rather the underlying migraine disease. Another study found no association between triptan prescription and stroke, concluding that triptan treatment in migraine does not increase the risk of stroke.
In summary, while there is an increased risk of cerebrovascular events in patients with migraine, Sumatriptan is unlikely to increase this risk if contraindications are observed.
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Frequently asked questions
Sumatriptan is a medication used to treat migraines and cluster headaches. While it has been associated with an increased risk of stroke, the evidence is inconclusive and the link is not yet fully understood. Sumatriptan is contraindicated for those with a history of stroke or transient ischaemic attacks.
Alternatives to sumatriptan for treating migraines include ergotamine and triptans. However, these medications also act as vasoconstrictors and may carry similar risks. Other options include antihypertensive agents such as beta-blockers and calcium channel blockers, angiotensin receptor blockers, and angiotensin-converting enzyme inhibitors.
Risk factors for stroke in people with migraines include younger age (under 45), female sex, smoking, oral contraceptive use, and a history of migraine with aura. Additionally, certain genetic factors and comorbidities, such as endothelial dysfunction and coagulation abnormalities, may also contribute to the increased risk.