The Food and Drug Administration (FDA) has approved a new mode of delivery for the antimigraine drug sumatriptan (known in pill form as Imitrex). Sumatriptan, now available as a transdermal patch and sold under the trade name Zecuity, is a serotonin-receptor agonist that binds to serotonin receptors, preventing the release of a proinflammatory neuropeptide. This is the first patch approved to treat acute migraine headache (meaning that a headache is treated after it occurs; the drug doesn't prevent the migraine).
The patch is 8 in. by 4 in. and is wrapped around the patient's arm or thigh. A computer chip and small battery embedded in the patch regulate the dose delivery. An electric current is used to move 6.5 mg of sumatriptan through the skin over four hours. A red light-emitting diode turns on when the system is activated and shuts off after the drug has been administered. If the migraine isn't completely resolved after one patch, a second may be used, although it should be placed in a different location.
Pain at the site, paresthesia, pruritus, warmth, and discomfort are the most common adverse effects. Nurses should teach patients how to apply and discard the patch. The patch shouldn't be cut. It should be applied to dry, intact, nonirritated skin that's relatively free of hair. It shouldn't be applied on a previously used application site until the site has been free of erythema for three days.
The patch contains metal parts and must be removed before the patient undergoes magnetic resonance imaging. It should be folded after use so that the adhesive side sticks to itself and then carefully discarded so that children and pets cannot access the drug. Because of the patch's lithium battery, local or state regulations may dictate how it is disposed of.
Contraindications to use of the sumatriptan patch include a history of coronary artery disease, Wolfe-Parkinson-White syndrome (or another cardiac accessory conduction pathway disorder), a history of stroke, transient ischemic attack, or hemiplegic or basilar migraine, peripheral vascular disease, ischemic bowel disease, and uncontrolled hypertension (see the complete FDA prescribing information at http://1.usa.gov/107yf5g for details).