Nomigran

Nomigran Uses, Dosage, Side Effects, Food Interaction and all others data.

Nomigran binds with high affinity to human cloned 5-HT1B/1D receptors. Nomigran presumably exerts its therapeutic effects in the treatment of migraine and cluster headaches through agonist effects at the 5-HT1B/1D receptors on intracranial blood vessels and sensory nerves of the trigeminal system, which result in cranial vessel constriction and inhibition of pro-inflammatory neuropeptide release.

Nomigran constricts cranial blood vessels and prevents the release of vasoactive peptides. The dose of sumatriptan varies widely by route of administration and in most cases, no more than 2 doses should be given daily. Medication overuse headaches may occur in patients who use sumatriptan frequently.

Trade Name Nomigran
Availability Prescription only
Generic Sumatriptan
Sumatriptan Other Names Sumatriptan, Sumatriptán, Sumatriptanum
Related Drugs Ubrelvy, Botox, prednisone, diclofenac, celecoxib, metoclopramide, verapamil, indomethacin, Imitrex, Reglan
Weight 50mg, 100mg
Type Tablet
Formula C14H21N3O2S
Weight Average: 295.4
Monoisotopic: 295.135447621
Protein binding

Sumatriptan is 14%-21% bound to protein in circulation.

Groups Approved, Investigational
Therapeutic Class 5-HT Agonists
Manufacturer Ambee Pharmaceuticals Ltd
Available Country Bangladesh
Last Updated: September 19, 2023 at 7:00 am
Nomigran
Nomigran

Uses

Nomigran Succinate is used for adults for the acute treatment of migraine (with or without aura), and the acute treatment of cluster headache.

Nomigran is also used to associated treatment for these conditions: Acute Migraine, Acute Cluster headaches

How Nomigran works

Nomigran is an agonist of 5-HT1B and 5-HT1D. This agonism leads to constriction of cranial blood vessels and inhibits the release of pro-inflammatory neuropeptides. Nomigran decreases carotid arterial blood flow, but increases blood flow velocity in the internal carotid artery and middle cerebral artery.

Dosage

Nomigran dosage

Migraine: 50-100 mg repeated at 2-hr intervals if migraine recurs. Max: 300 mg/24 hr.

Take thismedicationbymouthwith or without food as directed by your doctor, at the first sign of amigraine. The dosage is based on your medical condition and response to treatment. If there is no improvement in your symptoms, do not take more doses of this medication before talking to your doctor. If your symptoms are only partly relieved, or if yourheadachecomes back, you may take another dose at least two hours after the first dose. Do not take more than 200 milligrams in a 24-hour period.

If you are using drugs formigraineattacks on 10 or more days each month, the drugs may actually make yourheadachesworse (medication overuseheadache). Do not usemedicationsmore often or for longer than directed. Tell your doctor if you need to use this medication more often, or if the medication is not working as well, or if yourheadachesget worse.

Side Effects

Transient hypertension, hypotension, dizziness, flushing, fatigue, drowsiness, weakness, seizures, nausea and vomiting, heat, tightness in any part of body, paraesthesia, seizures, inj site reactions, irritation of nasal mucosa and epistaxis. Rebound headache with frequent use.

Toxicity

Symptoms of overdose include convulsions, tremor, paralysis, inactivity, ptosis, erythema of the extremities, abnormal respiration, cyanosis, ataxia, mydriasis, salivation, and lacrimation. Overdoses may be fatal and patients should be monitored for 3-5 half lives or while symptoms persist.

Precaution

Conditions predisposing to seizures, presence of coronary risk factors, cardiac arrhythmias, renal or hepatic impairment, elderly, pregnancy, lactation.

Interaction

Concurrent use increased risk of vasospastic reaction with ergotamine and related compounds.

Food Interaction

  • Avoid excessive or chronic alcohol consumption. Alcohol increased the risk of GI bleeding, ulcer, and perforation when taken with sumatriptan.
  • Take with or without food.

Nomigran Cholesterol interaction

[Major] The group of drugs known as 5-hydroxytryptamine1 receptor (5-HT1) agonists can cause vasospastic reactions, including coronary vasospasm, peripheral vascular ischemia, and colonic ischemia.

Rarely, serious adverse cardiac events including acute myocardial infarction, arrhythmia, cardiac arrest, and death have been reported within a few hours following the administration of 5-HT1 agonists, in some cases even in patients with no prior history or findings of coronary artery disease (CAD).

Significant elevation in blood pressure, including hypertensive crisis, has also been reported on rare occasions in patients with and without a history of hypertension, as have transient increases in blood pressure and peripheral vascular resistance.

In general, patients with potentially unrecognized CAD as predicted by the presence of risk factors (e.g., hypertension, hypercholesterolemia, tobacco use, obesity, diabetes, strong family history of CAD, female with surgical or physiological menopause, or male over 40 years of age) should not be administered 5-HT1 agonists unless a cardiovascular evaluation provides satisfactory clinical evidence indicating the lack of CAD, ischemic heart disease, or other significant underlying cardiovascular disease.

As a precaution, the manufacturers recommend that the first dose be administered under medical surveillance in such patients, and that electrocardiographic monitoring be considered during the interval immediately following administration to help detect any asymptomatic cardiac ischemia that may occur.

Periodic cardiovascular evaluations should be performed during intermittent, long-term use.

Volume of Distribution

Nomigran has a volume of distribution of 50±8L for a 6mg subcutaneous dose, or 2.7L/kg.

Elimination Route

A 6mg subcutaneous injection of sumatriptan reaches a Cmax of 69.5ng/mL (95% CI of 62.8-76.9ng/mL) with a Tmax of 0.17h (95% CI of 0.08-0.33h), an AUC of 9.0h*ng/mL (95% CI of 7.5-10.9h*ng/mL), and a bioavailability of 100%.

A 25mg oral dose of sumatriptan reaches a Cmax of 16.5ng/mL (95% CI of 13.5-20.1ng/mL) with a Tmax of 1.50h (95% CI of 0.50-2.00h), an AUC of 8.7h*ng/mL (95% CI of 6.1-12.5h*ng/mL), and a bioavailability of 14.3% (95% CI of 11.4-17.9%).

A 20mg intranasal dose of sumatriptan reaches a Cmax of 12.9ng/mL (95% CI of 10.5-15.9ng/mL) with a Tmax of 1.50h (95% CI of 0.25-3.00h), an AUC of 7.4h*ng/mL (95% CI of 5.0-10.8h*ng/mL), and a bioavailability of 15.8% (95% CI of 12.6-19.8%).

A 25mg rectal dose of sumatriptan reaches a Cmax of 22.9ng/mL (95% CI of 18.4-28.6ng/mL) with a Tmax of 1.00h (95% CI of 0.75-3.00h), an AUC of 14.6h*ng/mL (95% CI of 11.3-18.8h*ng/mL), and a bioavailability of 19.2% (95% CI of 15.3-24.1%).

Half Life

Subcutaneous sumatriptan has a half life of 1.9h (95% CI of 1.7-2.0h). Oral sumatriptan has a half life of 1.7h (95% CI of 1.4-1.9h). Rectal sumatriptan has a half life of 1.8h (95% CI of 1.6-2.2h). Intrsnasal sumatriptan has a half life of 1.8h (95% CI of 1.7-2.0h).

Clearance

Subcutaneous sumatriptan has a clearance of 0.22L/min (95% CI of 0.19-0.25L/min). Oral sumatriptan has a clearance of 0.17L/min (95% CI of 0.14-0.21L/min). Rectal sumatriptan has a clearance of 0.17L/min (95% CI of 0.14-0.21L/min). Intrsnasal sumatriptan has a clearance of 0.21L/min (95% CI of 0.18-0.25L/min). Total plasma clearance of sumatriptan is approximately 1200mL/min.

Elimination Route

22±4% is excreted in the urine as unchanged sumatriptan and 38±7% in urine as indole acetic acid approximately 40% is excreted in the feces.

Pregnancy & Breastfeeding use

Pregnancy Category C. Either studies in animals have revealed adverse effects on the foetus (teratogenic or embryocidal or other) and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the foetus.

Contraindication

Not to be used prophylactically and in patients with basilar or hemiplegic or ophthalmoplegic migraine. History of MI or stroke, severe hepatic impairment, ischaemic heart disease, uncontrolled hypertension, peripheral vascular disease, hypersensitivity to sulfonamides.

Innovators Monograph

You find simplified version here Nomigran

Nomigran contains Sumatriptan see full prescribing information from innovator Nomigran Monograph, Nomigran MSDS, Nomigran FDA label

FAQ

What is Nomigran used for?

Nomigran is used to treat migraine or cluster headaches once the pain has started, but there are other medicines available that may help to reduce the number and frequency of attacks.

How safe is Nomigran?

Taking too much Nomigran may make you very ill. An overdose can cause fainting, slowed heart rate, vomiting, loss of bladder and bowel control, and sleepiness. It can narrow your blood vessels leading to heart problems such as chest pains, abnormal heart rhythm or a heart attack.

How does Nomigran work?

Nomigran works on the serotonin receptors located on blood vessels in your brain. This causes them to narrow. This helps take away the headache and eases other symptoms such as feeling or being sick and sensitivity to light and sound.

What are the common side effects of Nomigran?

Common side effects of Nomigran are include :

  • flushing
  • tingling feeling
  • feeling warm or cold
  • drowsiness
  • tiredness
  • weakness
  • dizziness
  • upset stomach
  • diarrhea
  • nausea
  • muscle cramps

Is Nomigran safe during pregnancy?

Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.
Nomigran should only be given during pregnancy when benefit outweighs risk.

Is Nomigran safe during breastfeeding?

Nomigran is considered compatible with breastfeeding, as minimal amounts are excreted into milk.

Can I drink alcohol with Nomigran?

Alcohol does not affect how Nomigran works. However, it's best not to drink alcohol during a headache attack. Migraines and cluster headaches can sometimes be triggered by alcohol.

Can I drive after taking Nomigran?

Use Nomigran as soon as the migraine headache or cluster headache develops. It can make you feel tired or sleepy. If this happens, do not drive and do not use tools or machines.

When Is the best taken of Nomigran?

Take Nomigran as soon as a migraine or cluster headache starts. The tablets usually work within 30 to 60 minutes. The spray and injection work quicker.

How many hours does Nomigran last?

Nomigran is a short-acting medication with a half-life of around two hours. A Nomigran dose will be completely cleared from the body in 10 hours.

Should Nomigran be taken on an empty stomach?

Swallow the tablet whole with water or other liquids. Do not crush, break, or chew it. You may take the tablet with or without food.

Does Nomigran make me sleep?

Use Nomigran as soon as the migraine headache or cluster headache develops. It can make you feel tired or sleepy.

What does Nomigran feel like?

feeling warm or cold. tingling or prickling sensations in your skin. pressure or pain in your chest, neck, jaw, or throat.

Does Nomigran cause weight loss?

Weight loss isn't a direct side effect of Nomigran.

Is Nomigran hard on the kidneys?

The effect of reduced kidney function on how Nomigran acts in the body has not been evaluated. Nomigran is not recommended for use if you have reduced kidney function. 

Is Nomigran a sedative?

Nomigran can cause adverse central nervous system events outside migraine attacks. It can cause mild sedative effects such as sleepiness or fatigue.

Will Nomigran affect my fertility?

There's no firm evidence that Nomigran affects fertility in men or women.

Can Nomigran cause a miscarriage?

Three small studies do not suggest taking Nomigran in early pregnancy is linked to miscarriag.

Who should not take Nomigran?

People who have ever had a stroke or mini stroke,people with very high or uncontrolled high blood pressure,people with severe liver problems they should not take Nomigran.

What happens if I miss a dose?

Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.

Can I overdose on Nomigran?

Taking too much Nomigran may make you very ill. An overdose can cause fainting, slowed heart rate, vomiting, loss of bladder and bowel control, and sleepiness.

*** Taking medicines without doctor's advice can cause long-term problems.
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