The Medical Letter on Drugs and Therapeutics
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A Sumatriptan Patch (Zecuity) for Migraine
Revised 11/24/2015: In the Zecuity introductory paragraph "serotonin receptor antagonists" has been changed to "serotonin 1B/1D-receptor agonists".

The FDA has approved a sumatriptan iontophoretic transdermal system (Zecuity – Teva) for acute treatment of migraine in adults. Sumatriptan, the first of seven serotonin 1B/1D-receptor agonists (triptans) approved for this indication, is the most frequently prescribed migraine treatment in the US. It is also available in oral, intranasal, and injectable formulations.

RATIONALE FOR A PATCH — Patients with migraine who also have nausea, vomiting, or gastroparesis may not be able to take or absorb an oral triptan. Nasal sprays have a more rapid onset of action than oral formulations (10-15 vs 30-60 minutes), but they can have an unpleasant taste and they also depend on gastrointestinal absorption of the significant portion of the dose that is swallowed. Subcutaneously administered sumatriptan is the fastest acting (about 10 minutes) and most effective triptan formulation, but it causes more ... more      

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