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Published online: 29 September 2016
© Springer International Publishing Switzerland 2016
Abstract Sumatriptan nasal powder delivered by a breath powered delivery device (ONZETRA® Xsail®) is indicated for the acute treatment of migraine with or without aura in adults. This narrative review discusses the clinical use of sumatriptan nasal powder in this population and summarizes its pharmacological properties. In migraineurs, sumatriptan nasal powder treatment was associated with significantly greater rates of pain relief than placebo from 0.5-2 h postdose after a single treatment in the phase 3 TARGET trial, with these benefits sustained at 24 and 48 h postdose. Compared with oral sumatriptan, sumatriptan nasal powder was associated with significantly faster pain relief during the first 30 min after treatment in the phase 3 COMPASS trial assessing the treatment of up to five migraines in adults and better pain relief and pain freedom from 15 min to 1.5 h postdose. However, there were no between-group differences in pain relief at subsequent timepoints up to 48 h postdose. Sumatriptan nasal powder was generally well tolerated, with the majority of adverse events administration-site related and mild or moderate in severity. In conclusion, sumatriptan nasal powder is an effective and generally well tolerated treatment of migraine. With its novel breath powered nasal delivery resulting in a faster onset of action than oral sumatriptan, sumatriptan nasal powder provides a useful new option for the acute treatment of migraine with and without aura in adults.
1Introduction
Migraine is a disabling and prevalent neurovascular disorder [1], generally characterized by a headache with >2 characteristics of pulsation, unilateral location, moderate to severe intensity and worsening by routine physical activity, and is accompanied by >1 symptoms of nausea and/or vomiting, photophobia and phonophobia [2]. However, presenting symptoms may be heterogeneous among patients with different migraine subtypes.
Triptans are widely used in the acute treatment of migraines, with seven triptans currently available, including sumatriptan [3]. Sumatriptan is available in oral, liquid nasal spray and subcutaneous formulations [4]. With oral formulations associated with delayed absorption, other formulations, such as liquid nasal sprays, have been developed to provide more rapid absorption of the drug (Sect. 7). While sumatriptan liquid nasal spray offers a convenient alternative to conventional sumatriptan formulations, a limited fraction of the administered dose...