sumatriptan succinate

• コハク酸スマトリプタン

関

sumatriptan

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/09/25 00:26:26」(JST)

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Sumatriptan

Systematic (IUPAC) name
1-[3-(2-dimethylaminoethyl)-1H-indol-5-yl]- N-methyl-methanesulfonamide
Clinical data
Trade names	Imitrex, Imigran,Treximet
AHFS/Drugs.com	monograph
Licence data	US FDA:link
Pregnancy cat.	C
Legal status	℞-only (US)
Routes	tablet, subcutaneous injection, nasal spray
Pharmacokinetic data
Bioavailability	15% (oral)/ 96% (s.c)
Protein binding	14–21%
Metabolism	MAO
Half-life	2.5 hours
Excretion	60% urine; 40% feces
Identifiers
CAS number	103628-46-2 Y
ATC code	N02CC01
PubChem	CID 5358
IUPHAR ligand	54
DrugBank	DB00669
ChemSpider	5165 Y
UNII	8R78F6L9VO Y
KEGG	D00451 Y
ChEBI	CHEBI:10650 Y
ChEMBL	CHEMBL128 Y
Chemical data
Formula	C14H21N3O2S
Mol. mass	295.402 g/mol
SMILES O=S(=O)(NC)Cc1cc2c(cc1)ncc2CCN(C)C
InChI InChI=1S/C14H21N3O2S/c1-15-20(18,19)10-11-4-5-14-13(8-11)12(9-16-14)6-7-17(2)3/h4-5,8-9,15-16H,6-7,10H2,1-3H3 Y Key:KQKPFRSPSRPDEB-UHFFFAOYSA-N Y
Y (what is this?)  (verify)

Sumatriptan is a synthetic drug belonging to the triptan class, used for the treatment of migraine headaches. Structurally, it is an analog of the naturally occurring neuro-active alkaloids dimethyltryptamine (DMT), bufotenine, and 5-methoxy-dimethyltryptamine, with an N-methyl sulfonamidomethyl- group at position C-5 on the indole ring.

Sumatriptan is produced and marketed by various drug manufacturers with many different trade names such as Sumatriptan, Imitrex, Treximet, Imigran, Imigran recovery.

Adverse effects

Large doses of sumatriptan can cause sulfhemoglobinemia, a rare condition in which the blood changes from red to greenish-black, due to the integration of sulfur into the hemoglobin molecule. If sumatriptan is discontinued, the condition reverses within a few weeks.

Serious cardiac events, including some that have been fatal, have occurred following the use of sumatriptan injection or tablets. Events reported have included coronary artery vasospasm, transient myocardial ischemia, myocardial infarction, ventricular tachycardia, and ventricular fibrillation.^{[citation needed]}

The most common side-effects reported by at least 2% of patients in controlled trials of sumatriptan (25, 50, and 100 mg tablets) for migraine are atypical sensations (paresthesias and warm/cold sensations) reported by 4% in the placebo group and 5–6% in the sumatriptan groups, pain and other pressure sensations (including chest pain) reported by 4% in the placebo group and 6–8% in the sumatriptan groups, neurological events (vertigo) reported by less than 1% in the placebo group and less than 1% to 2% in the sumatriptan groups. Malaise/fatigue occurred in less than 1% of the placebo group and 2–3% of the sumatriptan groups. Sleep disturbance occurred in less than 1% in the placebo group to 2% in the sumatriptan group.

Mechanism of action

Sumatriptan is structurally similar to serotonin (5HT), and is a 5-HT (types 5-HT_1D and 5-HT_1B) agonist. The specific receptor subtypes it activates are present on the cranial arteries and veins. Acting as an agonist at these receptors, sumatriptan reduces the vascular inflammation associated with migraines.

The specific receptor subtype it activates is present in the cranial and basilar arteries. Activation of these receptors causes vasoconstriction of those dilated arteries. Sumatriptan is also shown to decrease the activity of the trigeminal nerve, which, it is presumed, accounts for sumatriptan's efficacy in treating cluster headaches. The injectable form of the drug has been shown to abort a cluster headache within fifteen minutes in 96% of cases.

Pharmacokinetics

Sumatriptan is administered in several forms; tablets, subcutaneous injection, and nasal spray. Oral administration (as succinate) suffers from poor bioavailability, partly due to presystemic metabolism—some of it gets broken down in the stomach and bloodstream before it reaches the target arteries. A new rapid-release tablet formulation has the same bioavailability, but the maximum concentration is achieved on average 10–15 minutes earlier. When injected, sumatriptan is faster-acting (usually within 10 minutes), but the effect lasts for a shorter time. Sumatriptan is metabolised primarily by monoamine oxidase A into an indole acetic acid analogue, part of which is further conjugated with glucuronic acid. These metabolites are excreted in the urine and bile. Only about 3% of the active drug may be recovered unchanged.

There is no simple, direct relationship between sumatriptan concentration (pharmacokinetics) per se in the blood and its anti-migraine effect (pharmacodynamics). This paradox has, to some extent, been resolved by comparing the rates of absorption of the various sumatriptan formulations, rather than the absolute amounts of drug that they deliver.

Approval

Sumatriptan was the first clinically available triptan (in 1991). In the United States, it is available only by medical prescription. However, it can be bought over the counter in the UK and Sweden in 50 mg dosage. Several dosage forms for sumatriptan have been approved, including tablets, solution for injection, and nasal inhalers.

On April 15, 2008, the US FDA approved Treximet, a combination of sumatriptan and naproxen, an NSAID. This combination has shown a benefit over either medicine used separately.

In July 2009, the US FDA approved a single-use jet injector formulation of sumatriptan. The device delivers a subcutaneous injection of 6 mg sumatriptan, without the use of a needle. Autoinjectors with needles have been previously available in Europe and North America for several years.

Phase III studies with a iontophoretic transdermal patch (Zelrix/Zecuity) started in July 2008. This patch uses low voltage controlled by a pre-programmed microchip to deliver a single dose of sumatriptan through the skin within 30 minutes.Zecuity was approved by the US FDA in January 2013.

Generics

Sumatriptan vials 100 5509

On November 6, 2008, Par Pharmaceutical announced that it would begin shipping generic versions of sumatriptan injection (sumatriptan succinate injection) 4 mg and 6 mg starter kits and 4 mg and 6 mg pre-filled syringe cartridges to the trade immediately. In addition, Par anticipates launching the 6 mg vials early in 2009.

Mylan Laboratories Inc., Ranbaxy, Sandoz, Dr. Reddy's Pharmaceuticals and other companies have received FDA approval for generic versions of Imitrex tablets in 25-, 50-, and 100-milligram doses since 2009. The drug is available in U.S. and European markets, since Glaxo's patent protections have expired in those jurisdictions. However, sales of a generic delivered via nasal spray are still restricted in the United States.

See also Sumavel DosePro (above).

Chemistry

U.S. Patent 4,785,016

References

UpToDate Contents

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• 1. 小児における片頭痛のマネージメント management of migraine headache in children
• 2. 成人における片頭痛の急性期治療 acute treatment of migraine in adults
• 3. 妊娠中および出産後の女性における頭痛 headache in pregnant and postpartum women
• 4. 成人における緊張型頭痛：急性期治療 tension type headache in adults acute treatment
• 5. 群発頭痛：治療および予後 cluster headache treatment and prognosis

English Journal

• Permeation of sumatriptan succinate across human skin using multiple types of self-dissolving microneedle arrays fabricated from sodium hyaluronate.

• Wu D1, Katsumi H1, Quan YS1,2, Kamiyama F2, Kusamori K1, Sakane T1, Yamamoto A1.
• Journal of drug targeting.J Drug Target.2016 Sep;24(8):752-8. doi: 10.3109/1061186X.2016.1154565. Epub 2016 Mar 14.
• Available formulations of sumatriptan succinate (SS) have low bioavailability or are associated with site reactions. We developed various types of self-dissolving microneedle arrays (MNs) fabricated from sodium hyaluronate as a new delivery system for SS and evaluated their skin permeation and irrit
• PMID 26878569

• Gi-protein-coupled 5-HT1B/D receptor agonist sumatriptan induces type I hyperalgesic priming.

• Araldi D1, Ferrari LF, Levine JD.
• Pain.Pain.2016 Aug;157(8):1773-82. doi: 10.1097/j.pain.0000000000000581.
• We have recently described a novel form of hyperalgesic priming (type II) induced by agonists at two clinically important Gi-protein-coupled receptors (Gi-GPCRs), mu-opioid and A1-adenosine. Like mu-opioids, the antimigraine triptans, which act at 5-HT1B/D Gi-GPCRs, have been implicated in pain chro
• PMID 27075428

• Characterization of a mouse model of headache.

• Huang D1, Ren L, Qiu CS, Liu P, Peterson J, Yanagawa Y, Cao YQ.
• Pain.Pain.2016 Aug;157(8):1744-60. doi: 10.1097/j.pain.0000000000000578.
• Migraine and other primary headache disorders affect a large population and cause debilitating pain. Establishing animal models that display behavioral correlates of long-lasting and ongoing headache, the most common and disabling symptom of migraine, is vital for the elucidation of disease mechanis
• PMID 27058678

Japanese Journal

• Formulation and Optimization of Orally Disintegrating Tablets of Sumatriptan Succinate

• Sheshala Ravi,Khan Nurzalina,Darwis Yusrida
• CHEMICAL & PHARMACEUTICAL BULLETIN 59(8), 920-928, 2011
• … The aims of the present research were to mask the intensely bitter taste of sumatriptan succinate and to formulate orally disintegrating tablets (ODTs) of the taste masked drug. … Taste masking was performed by coating sumatriptan succinate with Eudragit EPO using spray drying technique. …
• NAID 130000960921

• Development of Triptans in Japan : Bridging Strategy Based on the ICH-E5 Guideline

• Shimazawa Rumiko,Ando Yuki,Hidaka Shinji,Saito Kazuyuki,Toyoshima Satoshi,Kobayashi Fumiaki
• Journal of health science 52(4), 443-449, 2006-08-01
• … One was to conduct a placebo-controlled dose-response study as a bridging study in an attempt to extrapolate the data from the pivotal foreign Phase III studies including a repeated dose study (i.e., zolmitriptan, sumatriptan succinate, and eletriptan hydrobromide). … Another was to conduct a placebo-controlled Phase III study in Japan in an attempt to extrapolate the data for efficacy from a repeated dose study (i.e., sumatriptan and rizatriptan benzoate). …
• NAID 110006251401

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★リンクテーブル★

リンク元	「スマトリプタン」
関連記事	「succinate」

「スマトリプタン」

　　[★]

英

sumatriptan

化

コハク酸スマトリプタン sumatriptan succinate

商

イミグラン、Imitrex

関

片頭痛

「succinate」

　　[★] コハク酸、コハク酸塩、コハク酸エステル, succinic acid