Sumatriptan Succinate

Sumatriptan is effective for acute migraine across all four routes of administration (oral, subcutaneous, intranasal, rectal), but efficacy varies by route. Subcutaneous 6 mg provides the highest pain‑free rate at 2 hours (59% vs. 15% placebo; NNT 2.3), while oral 50 mg achieves complete relief in about 28% (NNT 6.1). Adverse events are generally mild and short‑lived, most common with subcutaneous and higher oral/intranasal doses. The authors conclude that route selection should balance efficacy, tolerability, cost, and patient preference, with subcutaneous being most potent but also most expensive and associated with more adverse effects.

Fig. 1 Calculated NNTs for a pain‐free response after a specified time, in participants treating moderate or severe migraine pain. (Derry CJ, et al., 2014)

This review summarizes AVP‑825 (ONZETRA® Xsail®), an intranasal sumatriptan powder delivery system for acute migraine. By exploiting nasal anatomy for efficient absorption, it achieves rapid uptake and lower systemic exposure than oral sumatriptan. Clinical studies demonstrate earlier onset of efficacy and a lower rate of atypical sensations than oral triptans, with mostly mild dysgeusia. The design aligns pharmacokinetics, anatomy, and device features to optimize acute migraine treatment, offering a fast‑acting, non‑oral alternative.

Fig. 2 AVP-825 for intranasal delivery of sumatriptan powder. (Tepper SJ, et al., 2018)