On the other hand, true allergic reaction to triptans is extremely rare, and cross-reactivity among triptans is unknown. Some triptans, including sumatriptan, contain a sulfonamide structure. However cross-reactivity between antibiotic sulfonamides and nonantibiotic sulfonamides does not occur, or at most has an extremely low potential.
The most common side effects of triptans, including sumatriptan—naproxen, are chest and neck pressure, tingling, paresthesia, flushing, dizziness and sedation. A major main concern when using triptans in general, including sumatriptan and hence sumatriptan—naproxen, is the cardiovascular safety. Serious cardiovascular events do occur rarely however, but it is in patients with multiple cardiovascular risk factors or known cardiovascular disease. Therefore, triptan should be considered safe in patients with no or low cardiovascular risk.
Though sumatriptan—naproxen shares a similar pharmacologic profile with its individual components, its pharmacokinetics are different. Maximal concentration C max for sumatriptan following administration of sumatriptan—naproxen occurs at approximately 1 hour median, range 0.
C max for naproxen following administration of sumatriptan—naproxen occurs at approximately 5 hours median, range 0. The mean C max for sumatriptan when given as sumatriptan—naproxen is similar to that of sumatriptan when given as a mg tablet alone. The median sumatriptan time to maximum concentration T max is only slightly different 1 hour for sumatriptan—naproxen and 1. The areas under the curve however for sumatriptan and for naproxen are similar for sumatriptan—naproxen compared to the individual tablets of its component.
Naproxen is almost completely albumin bound in the serum with a volume of distribution of 0. For the acute treatment of pain, it has a one hour onset of action. However, the onset of action of its anti-inflammatory effect is around 2 weeks, with a peak of action at 2—4 weeks. Its analgesic effect lasts up to 7 hours and its anti-inflammatory effect up to 12 hours. Only a minor fraction is excreted in feces. Urinary elimination consists of both the indole acetic metabolite as well as the unchanged drug.
It is recommended that sumatriptan, sumatriptan—naproxen and all other triptans be administered at the onset of headache, or as soon as possible in the migraine attack, but not during the aura symptoms that occur at the beginning of an attack. If the headache persists, then a second dose may be administered at 2 hours, with a maximum of 2 doses within a hour period. This is true for all formulations and all dosages. It is not recommended to combine different triptans.
There are no specific dose adjustments required in the elderly. Therefore one might therefore need to start with lower dosages. Similar to sumatriptan, sumatriptan—naproxen addresses both the headache and the nonheadache symptoms of migraine, namely photophobia, phonophobia and nausea.
Sumatriptan—naproxen shows consistency of response in other study designs too. In 2 identical, randomized, double-blind, placebo-controlled trials that enrolled and migraineurs respectively, with similar incidence of different migraine symptoms between the treated and the placebo group, after early treatment the nontraditional symptoms occurrence 2 hours and 4 hours post-treatment were significantly lower as compared to placebo Table 2.
Occurrence of nontraditional migraine symptoms 2-hour and 4-hour following treatment Sumatriptan—naproxen also showed superior efficacy and tolerability vs placebo in the treatment of menstrual migraine and dysmenorrhea in 2 replicate studies. This effect was seen for 2-hour pain response, 2 hour to 48 hours sustained pain response, use of rescue medications and in nonmigraine menstrual symptoms bloating, tiredness, irritability, overall nonmigraine pain intensity , except for menstrual pain.
Despite the advantage of sumatriptan—naproxen, there is a relative lack of data comparing it directly to its components. In addition, the efficacy of sumatriptan in the sumatriptan—naproxen studies is lower than was previously reported. A recent study identified 5 factors that predict patient adherence to triptan therapy.
A negative predictive factor was the occurrence of side effects. Migraine severity was not a predictive factor of adherence to therapy. Sumatriptan—naproxen, with its consistent efficacy response and favorable side effect profile increases the likelihood of adherence by patients.
Over a month period, it demonstrated consistent efficacy with low recurrence rates, and tolerability with low side effect rates and improved quality of life scores, again resulting in improved patient satisfaction and hence improved patient compliance. Sumatriptan—naproxen may restore responsiveness in subjects that have become tachyphylactic to triptans, and has a favorable side-effect profile, making it an effective and well-tolerated migraine abortive treatment, but it is far from being the gold standard treatment.
Research to develop additional medication is still needed. National Center for Biotechnology Information , U. Drug Des Devel Ther. Published online Feb Author information Copyright and License information Disclaimer. This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.
This article has been cited by other articles in PMC. Abstract Nonsteroidal anti-inflammatory drugs NSAIDs , including naproxen and naproxen sodium, are effective yet nonspecific analgesic and anti-inflammatory drugs, which work for a variety of pain and inflammatory syndromes, including migraine.
A recent guideline published by the European Federation of Neurologic Societies EFNS 11 lists the following symptomatic treatments for individual headache attacks or abortive therapy organized between specific and nonspecific treatments : nonspecific therapy with medications that relieve pain, including: i NSAIDs: aspirin, ibuprofen, naproxen, diclofenac, paracetamol, other NSAIDs and NSAIDs combined with nonNSAID analgesics, ii nonnarcotic pain medication: caffeine, tramadol; iii narcotics, noting that these are only of minor efficacy; iv anti-emetics: metoclopramide, domperidon; v cortico-steroids; vi intravenous valproate; vii semi-specific medications: isomethoptene, butalbital not in the EFNS guideline.
Overview of mode of action of sumatriptan—naproxen Since migraine has multiple pathogenic mechanisms at play, using combination therapy is an attractive modality. Overview of pharmacology of sumatriptan—naproxen Sumatriptan—naproxen has a similar side effect profile to sumatriptan. Overview of pharmacokinetics of sumatriptan—naproxen Though sumatriptan—naproxen shares a similar pharmacologic profile with its individual components, its pharmacokinetics are different.
Open in a separate window. Table 2 Occurrence of nontraditional migraine symptoms 2-hour and 4-hour following treatment All results significant at 0. Footnotes Disclosures The authors report no conflicts of interest in this work. References 1. Rasmussen BK. Epidemiology of headache. Epidemiology of tension-type headache. Migraine in the United States: a review of epidemiology and health care use.
The prevalence and characteristics of migraine in a population-based cohort: the GEM study. Lipton, et al. Headaches and face pain as a manisfestation of Munchausen Syndrome.
Work-related disability: results from the American migraine study. Healthcare resource and lost labour costs of migraine headache in the US. Healthcare resource use and costs associated with migraine in a managed healthcare setting.
Ann Pharmacother. Migraine prevalence, disease burden, and the need for preventive therapy. Rapoport AM. Acute treatment of headache. J Headache Pain. Epub Oct Eur J of Neurol. Nutley, NJ: Hawkey CJ. COX-2 inhibitors. Structural basis for selective inhibition of cyclooxygenase-2 by anti-inflammatory agents. Comparison of the cyclooxygenase-1 inhibitory properties of nonsteroidal anti-inflammatory drugs NSAIDs and selective COX-2 inhibitors, using sensitive microsomal and platelet assays.
Can J Physiol Pharmacol. The differential susceptibility of prostaglandin endoperoxide H synthases-1 and -2 to nonsteroidal anti-inflammatory drugs: aspirin derivatives as selective inhibitors.
Med Chem Res. Cryer B, Dubois A. The advent of highly selective inhibitors of cyclooxygenase — a review. Prostaglandins and Other Lipid Mediators. Simon LS. Role and regulation of cyclooxygenase-2 during inflammation. Am J Med. Naproxen absorption in children. Curr Med Res Opin. Naproxen in juvenile chronic polyarthritis. Ann Rheum Dis. Makela AL. Naproxen in the treatment of juvenile rheumatoid arthritis. Scand J Rheumatol. Long-term evaluation of naproxen suspension in juvenile chronic arthritis.
Naproxen and acetylsalicylic acid in the treatment of pauciarticular and polyarticular juvenile rheumatoid arthritis: assessment of tolerance and efficacy in a single-centre week double-blind parallel study. Multicentre study of piroxicam versus naproxen in juvenile chronic arthritis, with special reference to problem areas in clinical trials of nonsteroidal anti-inflammatory drugs in childhood. Br J Rheumatol. Naproxen sodium in the treatment of migraine.
Ann Intern Med. Advertisement - Continue Reading Below. More From Aches and Pains. Aches and Pains Medicines Can I take other medicines with nitrofurantoin? Can I take other medicines with paroxetine? Can I take other medicines with doxazosin? Can I take other medicines with lansoprazole? Choose collection at checkout and you can usually collect your treatment in as little as 1 hour from your local LloydsPharmacy.
Sumatriptan is a very effective treatment for migraines that comes as a tablet. We recommend that it is used together with over-the-counter pain relief. When used like this, it is the treatment of choice. We're registered with the Care Quality Commission. Take 1 tablet when the headache phase of your migraine begins. If you experience an aura visual disturbance , wait until this is over before taking Sumatriptan. If after 2 hours your migraine is not completely better, or has come back, you can take another tablet.
This can be repeated at 2-hour intervals. Do not take more than mg Sumatriptan in 24 hours. Side effects can include, feeling drowsy or dizzy, nausea and vomiting, shortness of breath, flushing feeling suddenly very hot and muscle aches. Less commonly pain or tightness in the chest. If chest pain is severe and does not pass quickly, seek urgent medical help. Rare but serious side effects can include, altered liver function, seizures, tremors, visual disturbances and severe allergic reactions.
For full information on side effects and correct use, see the patient information leaflet. Sumatriptan is available in 50mg and mg tablets. It is usually recommended to start with the lower dose. If this proves ineffective, your clinician may prescribe the mg tablets.
Do not take more than mg of Sumatriptan in 24 hours. The following treatments can be taken with Sumatriptan for maximum relief.
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