Fellow ClusterHeads,
Quick question for those of you who use or who have used imitrex nasal sprays. Have you experienced any side effects, specifially pain or tightness in the chest (listed as a side effect)?

I have taken imitex irregularly for the past 6 years or so during cycles, but this past week I started having chest discomfort throughout the day, ranging in discomfort level. I had been using about 2-3 nasal sprays for the two weeks prior. Went to the Doc on Tuesday morning and they checked me out, said everything related to my heart was normal and no indications that it was a heart related issue. They scheduled me for a stress test and will follow up after that. The discomfort continues for now with no real relief.

Thoughts?

Compared to six years ago, your arteries aren't getting any bigger or softer, if you get my drift. The effect of Imitrex, in any of its forms, is to constrict arteries. It doesn't discriminate as to which ones to constrict.

There are some people with cardiovascular issues who should not take Imitrex. Talk to a different doc and most importantly, listen to your body.

Until I discovered O2, Imitrex nasal spray was my major source of relief. During this past cycle (which ended in March) i still used it tho not as much. The main side effect for me has been a pronounced sensitivity of my hands to warm water when washing them making it feel much hotter than usual. But I do think caution is a good idea when it comes to its effect on your heart.

See the last few lines:

Headache. 2004 May;44(5):414-25.
Consensus statement: cardiovascular safety profile of triptans (5-HT agonists) in the acute treatment of migraine.

Dodick D, Lipton RB, Martin V, Papademetriou V, Rosamond W, MaassenVanDenBrink A, Loutfi H, Welch KM, Goadsby PJ, Hahn S, Hutchinson S, Matchar D, Silberstein S, Smith TR, Purdy RA, Saiers J; Triptan Cardiovascular Safety Expert Panel.

Department of Neurology, Mayo Clinic Scottsdale, AZ 85259, USA.

BACKGROUND: Health care providers frequently cite concerns about cardiovascular safety of the triptans as a barrier to their use. In 2002, the American Headache Society convened the Triptan Cardiovascular Safety Expert Panel to evaluate the evidence on triptan-associated cardiovascular risk and to formulate consensus recommendations for making informed decisions for their use in patients with migraine. OBJECTIVE: To summarize the evidence reviewed by the Triptan Cardiovascular Safety Expert Panel and their recommendations for the use of triptans in clinical practice. PARTICIPANTS: The Triptan Cardiovascular Safety Expert Panel was composed of a multidisciplinary group of experts in neurology, primary care, cardiology, pharmacology, women's health, and epidemiology. EVIDENCE AND CONSENSUS PROCESS: An exhaustive search of the relevant published literature was reviewed by each panel member in preparation for an open roundtable meeting. Pertinent issues (eg, cardiovascular pharmacology of triptans, epidemiology of cardiovascular disease, cardiovascular risk assessment, migraine) were presented as a prelude to group discussion and formulation of consensus conclusions and recommendations. Follow-up meetings were held by telephone. CONCLUSIONS: (1) MOST OF THE DATA ON TRIPTANS ARE DERIVED FROM PATIENTS WITHOUT KNOWN CORONARY ARTERY DISEASE. (2) CHEST SYMPTOMS OCCURRING DURING USE OF TRIPTANS ARE GENERALLY NONSERIOUS AND ARE NOT EXPLAINED BY ISCHEMIA. (3) THE INCIDENCE OF SERIOUS CARDIOVASCULAR EVENTS WITH TRIPTANS IN BOTH CLINICAL TRIALS AND CLINICAL PRACTICE APPEARS TO BE EXTREMELY LOW. (4) THE CARDIOVASCULAR RISK-BENEFIT PROFILE OF TRIPTANS FAVORS THEIR USE IN THE ABSENCE OF CONTRAINDICATIONS.

Publication Types:
Consensus Development Conference
Research Support, Non-U.S. Gov't
Review

PMID: 15147249 [PubMed - indexed for MEDLINE]

Quote:

Have you experienced any side effects, specifially pain or tightness in the chest (listed as a side effect)?

Sure, especially using the full 6mg the autoinjector pumps out. Not sure how much the squirt stuff administers, but once I dropped down to 2mg I found the side effects minimal and the relief optimal. Best to follow through with the cardio anyway. Blessings. lance

Thanks for the feedback guys. Given that I'm in excellent shape and the Doc said it most likely wasn't a heart related issue due to my vitals etc., I'll follow up with him as directed unless my pain increases or I have other symptoms.

Best of luck , follow the advise above, better safe than sorry. Glad to hear you have no heart issues.

I never did get any benefit from the nasal spray, only from sub-cutaneous injections... Beast reacts differently with all of us.

Oxygen as many have stated, is my number one abortive for many years now, and I haven't touched Imitrex since. Not that I wouldn't if I had to, just have not had to. I'm very thankful for that.

All the best,

Baer

I agree, the shot worked better for me, when it used to work. The spray never did. Unfortunately, my insurance absolutely would not budge on how much I could have, 2 shots per month...:(

ClosetCHer,

The topic of cardiac issues associated with use of triptans is contentious.  There are meta-studies that postulate there's no problem and that use of triptans does not result in vasoconstriction of cardiac tissues... but then in the same breath, they turn right around and say: "All triptans are contra-indicated in the presence of cardiovascular disease."

There are a few other studies that have shown that pushing the maximum daily dose of triptans can result in triptan induced angina...  even with no other indications of cardiovascular disease present.

Having experienced these symptoms a couple times was scary given I've had my heart checked every year from 1966 through 1991 during annual flight physicals and every two years since then.  I've always come away with a clean bill of health...

The first time this happened was while I was still episodic in 2004...  I pulled a Delta Sierra and chewed a 25 mg imitrex tablet during a particularly nasty K9 while flying from DC to LA... and a second 25 mg imitrex tablet on arrival at LAX when the CH hit again...  As much of the sumatriptan succinate stayed in my mouth, it amounted to a sublingual administration and a clear overdose...

The angina pain and tight chest stayed with me for nearly a week... Not fun at all so I went in for a checkup when I got home and the complete cardiac workup was negative for any heart problems. 

It happened again last September on a flight from DC to Seattle.  I'd taken a 50 mg. imitrex tablet a half hour prior to takeoff thinking the two hour imitrex half life would get me to SEA-TAC...  It didn't.  I got nailed half way there so used a snort of imitrex nasal spray at the first indication of an attack. 

I was confident the nasal spray would knock down what I thought was going to be a low level hit, but it blossomed into an onerous K8...  and didn't work...  After 45 minutes I took a second snort of imitrex nasal spray as the flight attendants were starting to show genuine angst...  A half hour later all was well, but by the time I picked up my bags, the angina pains were back and they lasted four days... 

That's one of the reasons I started working on the anti-inflammatory regimen...

Take care,

V/R, Batch