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Effect of Subcutaneous Sumatriptan, a Selective 5HT1 Agonist, on the Systemic, Pulmonary, and Coronary Circulation

BackgroundSumatriptan (GR43175) is a selective 5-hydroxytryptamine (SHT1) receptor agonist effective in the acute treatment of migraine. Recent in vitro experiments suggest that it has vasoactive properties in vascular beds distinct from the cerebral circulation. The object of this study was to assess the vasoactive effects of the standard 6-mg subcutaneous dose of sumatriptan used in migraine on the systemic and pulmonary circulations and the coronary artery vasculature. Methods and ResultsTen patients undergoing diagnostic coronary arteriography were studied with digital subtraction angiography and invasive hemodynamic monitoring. After subcutaneous injection of sumatriptan, there was no significant change in heart rate or ECG morphology. There was a significant rise in the systemic (20%, p<0.05 by ANOVA) and pulmonary arterial (40%o, p<0.05 by ANOVA) pressures. There was no change in cardiac output, but there was a significant increase in total systemic (27%, p<0.05) and total pulmonary vascular resistance (40%, p<0.05). Sumatriptan caused a significant reduction (p<0.001 by ANOVA) in mean absolute coronary artery diameter, from 436±1.60 mm at baseline to 3.67±1.49 mm (16%) at 10 minutes and to 3.63+1.49 mm (17%) at 30 minutes after injection. There were no clinical sequelae. ConclusionSumatriptan, a SHT, receptor agonist administered by the subcutaneous route, causes a vasopressor response in the systemic and pulmonary arterial circulations and coronary artery vasoconstriction.