Thomas Jefferson University, Jefferson Headache Center, Philadelphia, PA 19107, USA.
Expert Opin Pharmacother. 2013 Aug;14(12):1659-67. doi: 10.1517/14656566.2013.810209. Epub 2013 Jun 21.
Triptans are the first-line treatment for moderate-to-severe migraine headaches. Sumatriptan , the first triptan, is available in different formulations, including subcutaneous (SQ), intranasal, transdermal, oral, and suppository options.
Sumatriptan formulations have different pharmacokinetic, efficacy, and adverse event profiles. The fastest and most complete migraine relief occurs with SQ dosing; a needle-free option is available for patients fearful of injections. Oral administration is generally preferred by patients, although variability with absorption limits efficacy, especially for more severe attacks. Intranasal, transdermal, and suppository formulations are options for patients with nausea who do not require or prefer to avoid SQ administration. Transdermal treatment may be limited in some cases by skin irritation.
Patients should use an attack-based treatment approach for their migraine attacks to balance the speed of relief, efficacy, and tolerability. Different sumatriptan formulations allow its use as both first-line and rescue therapies, with additional treatment if needed. This article develops a treatment algorithm that offers suggested roles for different formulations of sumatriptan based on attack severity and response to initial sumatriptan therapy.
曲坦类药物是治疗中重度偏头痛的首选药物。舒马曲坦是第一个曲坦类药物，有多种剂型，包括皮下（SQ）、鼻内、经皮、口服和栓剂。
舒马曲坦的不同剂型具有不同的药代动力学、疗效和不良反应特征。SQ 给药可最快、最完全地缓解偏头痛；对于害怕注射的患者，有无需针头的选择。口服给药通常是患者的首选，尽管吸收的变异性限制了疗效，尤其是对于更严重的发作。对于有恶心但不需要或不愿避免 SQ 给药的患者，鼻内、经皮和栓剂制剂是可选方案。经皮治疗在某些情况下可能会受到皮肤刺激的限制。
患者应根据偏头痛发作情况采用基于发作的治疗方法，以平衡缓解速度、疗效和耐受性。不同的舒马曲坦剂型可作为一线和急救治疗药物，根据需要进行额外治疗。本文制定了一个治疗算法，根据发作严重程度和对初始舒马曲坦治疗的反应，为不同剂型的舒马曲坦提出了建议的作用。
