title: Sumatriptan iontophoretic transdermal system: a review of its use in patients with acute migraine.
abstract: The sumatriptan iontophoretic transdermal system (ZECUITY®) [hereafter referred to as sumatriptan TDS] is the first transdermal treatment for migraine to be approved by the US FDA. This article reviews the available pharmacologic properties of sumatriptan TDS and its clinical efficacy and tolerability for the acute treatment of adult patients with migraine with or without aura. Sumatriptan, a selective 5-hydroxy-tryptamine receptor subtype 1 (5-HT₁) agonist, is presumed to exert its therapeutic effect on migraine patients by binding to the 5-HT(1B/1D) receptors on intracranial blood vessels and sensory nerves of the trigeminal system, resulting in cranial vessel constriction and the inhibition of the release of pro-inflammatory neuropeptides and plasma extravasation. In a well designed, phase III clinical trial, sumatriptan TDS was shown to be more effective than placebo at treating a single migraine attack, with significantly more sumatriptan TDS than placebo recipients being headache pain free and nausea free at 2 hours. These data were supported by a long-term, repeat-use study over 12 months. Additionally, sumatriptan TDS was generally well tolerated in clinical trials; the most common adverse events were application-site reactions. The sumatriptan TDS formulation avoids the gastrointestinal tract, and has a controlled, sustained delivery, allowing for patients with migraine-associated nausea and vomiting to receive treatment without the risk of inconsistent absorption or avoidance of tablet use (associated with oral delivery of the drug in these patients). Moreover, it may offer a useful alternative to the nasal spray or subcutaneous sumatriptan formulations. However, definitive conclusions on the comparative efficacy and tolerability of sumatriptan TDS versus other sumatriptan formulations or other migraine drugs are not as yet possible, and data from comparative trials would be of great interest. Sumatriptan TDS is a useful addition to the treatment options available to migraine patients.
authors.affiliation: Adis, 41 Centorian Drive, Private Bag 65901, Mairangi Bay, North Shore, 0754, Auckland, New Zealand, demail@springer.com.
authors.forename: Karly P
authors.initials: KP
authors.lastname: Garnock-Jones
mesh_terms: D059787:Acute Pain / Q000209:etiology / Q000517:prevention & control; D000279:Administration, Cutaneous; D000328:Adult; D016503:Drug Delivery Systems / Q000009:adverse effects; D003875:Drug Eruptions; D006801:Humans; D007478:Iontophoresis / Q000009:adverse effects; D008881:Migraine Disorders / Q000188:drug therapy* / Q000503:physiopathology / Q000517:prevention & control; D055502:Secondary Prevention; D058825:Serotonin 5-HT1 Receptor Agonists / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D012720:Severity of Illness Index; D012867:Skin / Q000187:drug effects / Q000276:immunology; D018170:Sumatriptan / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D014662:Vasoconstrictor Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use
chemical_list: D058825:Serotonin 5-HT1 Receptor Agonists; D014662:Vasoconstrictor Agents; D018170:Sumatriptan
references.citation: Neurol Sci. 2012 May;33 Suppl 1:S119-25
references.pmid: 22644186
references.citation: Drugs. 1992 May;43(5):776-98
references.pmid: 1379152
references.citation: Headache. 2013 Jan;53(1):93-103
references.pmid: 23148774
references.citation: J Clin Hypertens (Greenwich). 2013 Aug;15(8):600-5
references.pmid: 23889724
references.citation: Neurotherapeutics. 2010 Apr;7(2):176-82
references.pmid: 20430316
references.citation: Headache. 2012 Feb;52(2):204-12
references.pmid: 22229837
references.citation: CNS Drugs. 2010 Nov;24(11):929-40
references.pmid: 20932065
references.citation: Neuropsychiatr Dis Treat. 2012;8:429-34
references.pmid: 23055737
references.citation: Drugs. 1998 Jun;55(6):889-922
references.pmid: 9617601
references.citation: Headache. 2012 Apr;52(4):612-24
references.pmid: 22352764
references.citation: Headache. 2009 Jun;49(6):817-25
references.pmid: 19438727
references.citation: Neurology. 2000 Sep 26;55(6):754-62
references.pmid: 10993991
references.citation: Neurotherapeutics. 2010 Apr;7(2):159-63
references.pmid: 20430314
references.citation: Drugs. 1994 Apr;47(4):622-51
references.pmid: 7516861
references.citation: Headache. 2012 Oct;52(9):1402-10
references.pmid: 22694484
references.citation: Curr Treat Options Neurol. 2012 Feb;14(1):50-9
references.pmid: 22090312
references.citation: Pharm Res. 2007 Oct;24(10):1919-26
references.pmid: 17577644