Siagran Special Precautions

Use Sumatriptan only when a clear diagnosis of migraine has been established. In patients not previously diagnosed with migraine attacks in those with a history of migraine presenting with atypical symptoms, care should be taken to exclude other potentially serious neurologic conditions before initiation of Sumatriptan therapy.
Sumatriptan should not be used for prophylaxis.
Excessive use of drugs for the management of acute migraine attacks; for 10 or more days per month, may result in migraine-like daily headaches or a marked increase in the frequency of migraine attacks. Withdrawal of the overused drugs, treatment of withdrawal symptoms and consideration of prophylactic therapy for migraine attacks may be necessary.
Patients with multiple cardiovascular risk factors (e.g. postmenopausal women, men older than 40 years, patients with risk factors such as hypertension, hypercholesterolemia, obesity, diabetes, smoking, or history of coronary artery disease) who have not previously received therapy with a 5-HT₁ receptor agonist should undergo cardiovascular evaluation prior to initiation of Sumatriptan therapy. Moreover, patients who experience sensations of chest pain/pressure/tightness or symptoms suggestive of angina following dosing should be evaluated for coronary artery disease or Prinzmetal's angina before receiving additional doses. And it's recommended that patients who are intermittent long-term to use 5-HT₁ agonist, undergo periodic interval cardiovascular evaluation.
Anaphylactic, anaphylactoid and hypersensitivity reactions have been reported. Particularly, patients with known hypersensitivity to sulphonamides may exhibit an allergic reaction following Sumatriptan administration. Even though evidence of cross-sensitivity is limited.
Sumatriptan should be used with caution in patients with controlled hypertension, and blood pressure should be monitored in all patients receiving the drug.
Sumatriptan can caused drowsiness. Also, patients should be advised to avoid performing hazardous activities that require mental alertness (e.g. Operating machinery, driving a motor vehicle).
There have been rare reports of seizure after use of Sumatriptan and it should be used with caution in patients with a history of epilepsy or other conditions predisposing to seizures.
Sumatriptan should be used with caution in patients with diseases that may alter the absorption, metabolism, or excretion of the drug, e.g. impaired renal or hepatic function. Use the oral formulation with caution (and with dosage limitations) in patients with mild to moderate hepatic impairment.
Concurrent use Sumatriptan with selective serotonin-reuptake inhibitors (SSRIs: e.g. fluoxetine, fluvoxamine, paroxetine, sertraline) or norepinephrine-reuptake inhibitors (SNRIs: e.g. duloxetine) can cause serotonin syndrome. If concomitant treatment is clinically warranted, the patients should be observed carefully particularly, during initiation of therapy, when dosage is increase, or when another serotonergic agent is initiated. In addition, patients should be advised of potential drug interaction symptoms; mental status changes including weakness, progressive agitation, tingling, incoordination, chest pain, dyspnea and be instructed to report such symptoms to their clinician immediately.