Patient leaflet - IMIGRAN SUBJECT
1. what imigran subject is and what it is used for
Each Imigran Subject pre-filled cartridge syringe contains a single dose of sumatriptan, which belongs to a group of medicines called triptans (also known as 5-HT 1 receptor agonists).
Imigran Subject is used to treat migraine headache and a rare condition called cluster headache.
Migraine and cluster headache symptoms may be caused by the temporary widening of blood vessels in the head. Imigran Subject is believed to reduce the widening of these blood vessels. This in turn helps to take away the headache and relieve other symptoms such as feeling or being sick (nausea or vomiting) and sensitivity to light and sound.
2. what you need to know before you use imigran subject
Don’t use Imigran Subject:
- If you’re allergic to sumatriptan, or any of the other ingredients of this medicine (listed in section 6)
- If you have a heart problem such as narrowing of the arteries (ischaemic heart disease) or chest pains (angina), or have already had a heart attack
- If you have circulation problems in your legs that cause cramp-like pains when you walk (peripheral vascular disease)
- If you have had a stroke or a mini-stroke (also called a transient ischaemic attack or TIA)
- If you have high blood pressure. You may be able to use Imigran if your high blood pressure is mild and is being treated
- If you have serious liver disease
- With other migraine medicines, including those which contain ergotamine, or similar medicines such as methysergide maleate; or any triptan or 5-HT1 agonist (such as naratriptan or zolmitriptan)
- With any of the following anti-depressants:
- MAOIs (monoamine oxidase inhibitors) or if you have taken an MAOI in the last 2 weeks
- SSRIs (selective serotonin reuptake inhibitors) including citalopram, fluoxetine, fluvoxamine, paroxetine and sertraline
- SNRIs (serotonin noradrenaline reuptake inhibitors) including venlafaxine or duloxetine.
- For children under 18 years of age.
If any of these apply to you:
^Tell your doctor, and don’t use Imigran Subject.
Take special care with Imigran Subject
Talk to your doctor or pharmacist before using Imigran.
If you have any extra risk factors
- If you are a heavy smoker or are using nicotine replacement therapy, and especially
- If you are a man aged over 40, or
- If you are a woman who has been through the menopause
In very rare cases, people have developed serious heart conditions after using Imigran, even though they had no signs of heart disease before. If any of the points above applies to you it could mean you have a greater risk of developing heart disease – so:
^ Tell your doctor so that your heart function can be checked before Imigran is prescribed for you
If you have a history of fits (seizures)
Or if you have other conditions which might make it more likely that you’ll have a fit – for example, a head injury or alcoholism:
^Tell your doctor so that you can be supervised more closely.
If you have had high blood pressure Imigran may not be suitable for you ^Tell your doctor or pharmacist before using Imigran.
If you have liver or kidney disease
If either of these apply to you:
^Tell your doctor or pharmacist before using Imigran.
If you are allergic to antibiotics called sulphonamides
If so, you may also be allergic to Imigran. If you know you are allergic to an antibiotic but you are not sure whether it is a sulphonamide:
^Tell your doctor or pharmacist before using Imigran.
If you are taking anti-depressants called SSRIs
(Selective Serotonin Reuptake Inhibitors) or SNRIs (Serotonin Noradrenaline Reuptake Inhibitors)
^Tell your doctor or pharmacist before using Imigran.
Also see Other medicines and Imigran, below.
Imigran syringe may contain latex
The syringe needle shield may contain latex.
^ Tell your doctor if you are allergic to latex.
If you use Imigran frequently
Using Imigran too often may make your headaches worse.
^Tell your doctor if this applies to you. He or she may recommend you stop using Imigran.
If you feel pain or tightness in your chest after you use Imigran
These effects may be intense but they usually pass quickly. If they don’t pass quickly, or they become severe:
^Get medical help immediately. Section 4 (below) has more information about these possible side effects.
Other medicines and Imigran
Tell your doctor or pharmacist if you’re taking, have recently taken or might take any other medicines. This includes any herbal products or medicines you’ve bought without a prescription.
Some medicines must not be taken with Imigran and others may cause adverse effects if they’re taken with Imigran.
You must tell your doctor if you are taking :
- ergotamine also used to treat migraine, or similar medicines such as methysergide (see section 2 Don’t use Imigran Subject). Don’t use Imigran at the same time as these medicines. Stop taking these medicines at least 24 hours before using Imigran. Don’t take any medicines which contain ergotamine or compounds similar to ergotamine again for at least 6 hours after using Imigran.
- other triptans/5-HT1 receptor agonists (such as naratriptan, rizatriptan, zolmitriptan), also used to treat migraine, (see section 2 Don’t use Imigran Subject). Don’t use Imigran at the same time as these medicines. Stop taking these medicines at least 24 hours before using Imigran. Don’t take another triptan/5-HT1 receptor agonist for at least 24 hours after using Imigran.
- MAOIs used to treat depression. Don’t use Imigran if you have taken these in the last 2 weeks.
- SSRIs and SNRIs used to treat depression. Using Imigran with these medicines can cause serotonin syndrome (a collection of symptoms which can include restlessness, confusion, sweating, hallucinations, increased reflexes, muscle spasms, shivering, increased heartbeat and shaking). Tell your doctor immediately if you are affected in this way.
- St John’s Wort (Hypericum perforatum). Taking herbal remedies containing St John’s Wort while using Imigran may make side effects more likely.
Pregnancy and breast-feeding
- If you are pregnant, think you may be pregnant or are planning to have a baby, ask your doctor for advice before taking this medicine. There is only limited information about the safety of Imigran for pregnant women, though up till now there is no evidence of any increased risk of birth defects. Your doctor will discuss with you whether or not you should use Imigran while you are pregnant
- Don’t breast-feed your baby for 12 hours after using Imigran. If you express any breast milk during this time, discard the milk and don’t give it to your baby.
Driving and using machines
Either the symptoms of migraine or your medicine may make you drowsy. If you are affected, don’t drive or operate machinery.
Imigran Subject contains
- Sodium: This medicine contains less than 1 mmol sodium (23 mg) per syringe, that is to say essentially ‘sodium-free’.
3. how to use imigran subject
Always use this medicine exactly as your doctor has told you. Check with your doctor or pharmacist if you are not sure.
Imigran Subject is usually injected into the thigh.
There’s a step-by-step guide to using the syringe at the end of this leaflet (see section 7 overleaf).
When to use Imigran
- It’s best to use Imigran as soon as you feel a migraine or a cluster headache coming on, although you can use it at any time during an attack
- Don’t use Imigran to try to prevent an attack – only use it after your migraine symptoms start.
How much to use
Adults aged 18 to 65
- The usual dose for adults aged 18 to 65 with migraine or a cluster headache is one 6 mg injection.
Children under 18
- Imigran is not recommended for children under 18 years old.
Older people (aged over 65)
- Imigran is not recommended for people aged over 65.
If your symptoms start to come back
- You can use a second Imigran injection if at least 1 hour has passed since the first injection.
If the first injection has no effect
- Don’t use a new injection or any other Imigran preparation for the same attack.
If Imigran doesn’t give you any relief:
^Ask your doctor or pharmacist for advice.
If you use more Imigran than you should
Using too much Imigran could make you ill. If you have used more than two injections in 24 hours:
^Contact your doctor for advice.
If you have further questions about the use of this medicine, ask your doctor or pharmacist.
4. possible side effects
Like all medicines, this medicine can cause side effects, but not everybody gets them. Some symptoms may be caused by the migraine itself.
Allergic reaction: get doctor’s help straight away
The following side effects have occurred but their exact frequency is not known.
- The signs of allergy include rash, hives (itchy rash); wheezing; swollen eyelids, face or lips; complete collapse.
If you get any of these symptoms soon after using Imigran:
^Don’t use any more. Contact a doctor straight away.
Very common side effects
(affect more than 1 in 10 people)
- Temporary pain at the site of injection
- Stinging or burning, redness, swelling, bruising and bleeding at the site of injection.
Common side effects
(affect up to 1 in 10 people)
- Pain, heaviness, pressure or tightness in the chest, throat or other parts of the body, or unusual sensations, including numbness, tingling and warmth or cold. These effects may be intense but generally pass quickly.
If these effects continue or become severe (especially the chest pain):
^Get medical help urgently. In a very small number of people these symptoms can be caused by a heart attack.
Other common side effects include:
- Feeling sick (nausea) or being sick (vomiting), although this may be due to the migraine itself
- Tiredness or drowsiness
- Dizziness, feeling weak, or getting hot flushes
- Temporary increase in blood pressure