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Drug Information for IMITREX (sumatriptan succinate) InjectionFor Subcutaneous Use Only. (GlaxoSmithKline LLC): ADVERSE REACTIONS
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Serious cardiac events, including some that have been fatal, have occurred following the use of IMITREX Injection or Tablets. These events are extremely rare and most have been reported in patients with risk factors predictive of CAD. Events reported have included coronary artery vasospasm, transient myocardial ischemia, myocardial infarction, ventricular tachycardia, and ventricular fibrillation (see CONTRAINDICATIONS, WARNINGS: Risk of Myocardial Ischemia and/or Infarction and Other Adverse Cardiac Events, and PRECAUTIONS: General).
Significant hypertensive episodes, including hypertensive crises, have been reported on rare occasions in patients with or without a history of hypertension (see WARNINGS: Increase in Blood Pressure).
Among patients in clinical trials of subcutaneous IMITREX Injection (N = 6,218), up to 3.5% of patients withdrew for reasons related to adverse events.
Incidence in Controlled Clinical Trials of Migraine Headache
Table 4 lists adverse events that occurred in 2 large US, Phase III, placebo-controlled clinical trials in migraine patients following either a single 6-mg dose of IMITREX Injection or placebo. Only events that occurred at a frequency of 2% or more in groups treated with IMITREX Injection 6 mg and occurred at a frequency greater than the placebo group are included in Table 4.
Table 4. Treatment Emergent Adverse Experience Incidence in 2 Large Placebo-Controlled Migraine Clinical Trials: Events Reported by at Least 2% of Patients Treated With IMITREX Injection 6 mga
Percent of Patients Reporting
6 mg Subcutaneous
(n = 547)
(n = 370)
Feeling of heaviness
Feeling of tightness
Tight feeling in head
Tightness in chest
Pressure in chest
Ear, nose, and throat
Discomfort: nasal cavity/sinuses
Injection site reaction
aThe sum of the percentages cited is greater than 100% because patients may experience more than 1 type of adverse event. Only events that occurred at a frequency of 2% or more in groups treated with IMITREX Injection and occurred at a frequency greater than the placebo groups are included.
The incidence of adverse events in controlled clinical trials was not affected by gender or age of the patients. There were insufficient data to assess the impact of race on the incidence of adverse events.
Incidence in Controlled Trials of Cluster Headache
In the controlled clinical trials assessing sumatriptan’s efficacy as a treatment for cluster headache, no new significant adverse events associated with the use of sumatriptan were detected that had not already been identified in association with the drug’s use in migraine.
Overall, the frequency of adverse events reported in the studies of cluster headache were generally lower. Exceptions include reports of paresthesia (5% IMITREX, 0% placebo), nausea and vomiting (4% IMITREX, 0% placebo), and bronchospasm (1% IMITREX, 0% placebo).
Other Events Observed in Association With the Administration of IMITREX Injection
In the paragraphs that follow, the frequencies of less commonly reported adverse clinical events are presented. Because the reports include events observed in open and uncontrolled studies, the role of IMITREX Injection in their causation cannot be reliably determined. Furthermore, variability associated with adverse event reporting, the terminology used to describe adverse events, etc., limit the value of the quantitative frequency estimates provided.
Event frequencies are calculated as the number of patients reporting an event divided by the total number of patients (N = 6,218) exposed to subcutaneous IMITREX Injection. All reported events are included except those already listed in the previous table, those too general to be informative, and those not reasonably associated with the use of the drug. Events are further classified within body system categories and enumerated in order of decreasing frequency using the following definitions: frequent adverse events are defined as those occurring in at least 1/100 patients, infrequent adverse events are those occurring in 1/100 to 1/1,000 patients, and rare adverse events are those occurring in fewer than 1/1,000 patients.
Infrequent were hypertension, hypotension, bradycardia, tachycardia, palpitations, pulsating sensations, various transient ECG changes (nonspecific ST or T wave changes, prolongation of PR or QTc intervals, sinus arrhythmia, nonsustained ventricular premature beats, isolated junctional ectopic beats, atrial ectopic beats, delayed activation of the right ventricle), and syncope. Rare were pallor, arrhythmia, abnormal pulse, vasodilatation, and Raynaud syndrome.
Endocrine and Metabolic
Infrequent was thirst. Rare were polydipsia and dehydration.
Frequent was vision alterations. Infrequent was irritation of the eye.
Frequent were abdominal discomfort and dysphagia. Infrequent were gastroesophageal reflux and diarrhea. Rare were peptic ulcer, retching, flatulence/eructation, and gallstones.
Frequent were muscle cramps. Infrequent were various joint disturbances (pain, stiffness, swelling, ache). Rare were muscle stiffness, need to flex calf muscles, backache, muscle tiredness, and swelling of the extremities.
Frequent was anxiety. Infrequent were mental confusion, euphoria, agitation, relaxation, chills, sensation of lightness, tremor, shivering, disturbances of taste, prickling sensations, paresthesia, stinging sensations, facial pain, photophobia, and lacrimation. Rare were transient hemiplegia, hysteria, globus hystericus, intoxication, depression, myoclonia, monoplegia/diplegia, sleep disturbance, difficulties in concentration, disturbances of smell, hyperesthesia, dysesthesia, simultaneous hot and cold sensations, tickling sensations, dysarthria, yawning, reduced appetite, hunger, and dystonia.
Infrequent was dyspnea. Rare were influenza, diseases of the lower respiratory tract, and hiccoughs.
Infrequent were erythema, pruritus, and skin rashes and eruptions. Rare was skin tenderness.
Rare were dysuria, frequency, dysmenorrhea, and renal calculus.
Infrequent were miscellaneous laboratory abnormalities, including minor disturbances in liver function tests, “serotonin agonist effect,” and hypersensitivity to various agents. Rare was fever.
Other Events Observed in the Clinical Development of IMITREX
The following adverse events occurred in clinical trials with IMITREX Tablets and IMITREX Nasal Spray. Because the reports include events observed in open and uncontrolled studies, the role of IMITREX in their causation cannot be reliably determined. All reported events are included except those already listed, those too general to be informative, and those not reasonably associated with the use of the drug.
Breast swelling, cysts, disorder of breasts, lumps, masses of breasts, nipple discharge, primary malignant breast neoplasm, and tenderness.
Abdominal aortic aneurysm, angina, atherosclerosis, cerebral ischemia, cerebrovascular lesion, heart block, peripheral cyanosis, phlebitis, thrombosis, and transient myocardial ischemia.
Ear, Nose, and Throat
Allergic rhinitis; disorder of nasal cavity/sinuses; ear, nose, and throat hemorrhage; ear infection; external otitis; feeling of fullness in the ear(s); hearing disturbances; hearing loss; Meniere disease; nasal inflammation; otalgia; sensitivity to noise; sinusitis; tinnitus; and upper respiratory inflammation.
Endocrine and Metabolic
Elevated thyrotropin stimulating hormone (TSH) levels; endocrine cysts, lumps, and masses; fluid disturbances; galactorrhea; hyperglycemia; hypoglycemia; hypothyroidism; weight gain; and weight loss.
Accommodation disorders, blindness and low vision, conjunctivitis, disorders of sclera, external ocular muscle disorders, eye edema and swelling, eye hemorrhage, eye itching, eye pain, keratitis, mydriasis, and visual disturbances.
Abdominal distention, colitis, constipation, dental pain, dyspeptic symptoms, feelings of gastrointestinal pressure, gastric symptoms, gastritis, gastroenteritis, gastrointestinal bleeding, gastrointestinal pain, hematemesis, hypersalivation, hyposalivation, intestinal obstruction, melena, nausea and/or vomiting, oral itching and irritation, pancreatitis, salivary gland swelling, and swallowing disorders.
Mouth and Teeth
Disorder of mouth and tongue (e.g., burning of tongue, numbness of tongue, dry mouth).
Acquired musculoskeletal deformity, arthralgia and articular rheumatitis, arthritis, intervertebral disc disorder, muscle atrophy, muscle tightness and rigidity, musculoskeletal inflammation, and tetany.
Apathy, aggressiveness, bad/unusual taste, bradylogia, cluster headache, convulsions, depressive disorders, detachment, disturbance of emotions, drug abuse, facial paralysis, hallucinations, heat sensitivity, incoordination, increased alertness, memory disturbance, migraine, motor dysfunction, neoplasm of pituitary, neuralgia, neurotic disorders, paralysis, personality change, phobia, phonophobia, psychomotor disorders, radiculopathy, raised intracranial pressure, rigidity, stress, syncope, suicide, and twitching.
Asthma, breathing disorders, bronchitis, cough, and lower respiratory tract infection.
Dry/scaly skin, eczema, herpes, seborrheic dermatitis, skin nodules, tightness of skin, and wrinkling of skin.
Abnormal menstrual cycle, abortion, bladder inflammation, endometriosis, hematuria, increased urination, inflammation of fallopian tubes, intermenstrual bleeding, menstruation symptoms, micturition disorders, urethritis, and urinary infections.
Contusions, difficulty in walking, edema, hematoma, hypersensitivity, fever, fluid retention, lymphadenopathy, overdose, speech disturbance, swelling of extremities, swelling of face, and voice disturbances.
Pain and Other Pressure Sensations
Chest pain and/or heaviness, neck/throat/jaw pain/tightness/pressure, and pain (location specified).
Postmarketing Experience (Reports for Subcutaneous or Oral Sumatriptan)
The following section enumerates potentially important adverse events that have occurred in clinical practice and that have been reported spontaneously to various surveillance systems. The events enumerated represent reports arising from both domestic and nondomestic use of oral or subcutaneous dosage forms of sumatriptan. The events enumerated include all except those already listed in the ADVERSE REACTIONS section above or those too general to be informative. Because the reports cite events reported spontaneously from worldwide postmarketing experience, frequency of events and the role of IMITREX Injection in their causation cannot be reliably determined. It is assumed, however, that systemic reactions following sumatriptan use are likely to be similar regardless of route of administration.
Hemolytic anemia, pancytopenia, thrombocytopenia.
Atrial fibrillation, cardiomyopathy, colonic ischemia (see WARNINGS), Prinzmetal variant angina, pulmonary embolism, shock, thrombophlebitis.
Ear, Nose, and Throat
Ischemic optic neuropathy, retinal artery occlusion, retinal vein thrombosis, loss of vision.
Ischemic colitis with rectal bleeding (see WARNINGS), xerostomia.
Elevated liver function tests.
Central nervous system vasculitis, cerebrovascular accident, dysphasia, serotonin syndrome, subarachnoid hemorrhage.
Angioneurotic edema, cyanosis, death (see WARNINGS), temporal arteritis.
Bronchospasm in patients with and without a history of asthma.
Exacerbation of sunburn, hypersensitivity reactions (allergic vasculitis, erythema, pruritus, rash, shortness of breath, urticaria; in addition, severe anaphylaxis/anaphylactoid reactions have been reported [see WARNINGS: Hypersensitivity]), photosensitivity. Following subcutaneous administration of sumatriptan, pain, redness, stinging, induration, swelling, contusion, subcutaneous bleeding, and, on rare occasions, lipoatrophy (depression in the skin) or lipohypertrophy (enlargement or thickening of tissue) have been reported.
Acute renal failure.
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