Sumatriptan with naproxen

How it works

Sumatriptan causes cranial vasoconstriction and inhibits trigeminal neuropeptide release, while naproxen inhibits cyclo-oxygenase to reduce prostaglandin-mediated neurogenic inflammation, giving complementary actions.

Prescribing in practice

• It is contraindicated in ischaemic heart disease, coronary vasospasm, uncontrolled hypertension and cerebrovascular disease because of the triptan, and the naproxen component adds gastrointestinal, renal and cardiovascular NSAID risks.
• It must not be combined with ergot derivatives or other triptans, and caution is needed with serotonergic drugs because of serotonin syndrome risk.
• Frequent use of acute migraine treatment can cause medication-overuse headache, so frequency of attacks and treatment days should be reviewed.

Monitoring

Monitor blood pressure, headache frequency and gastrointestinal and renal tolerance with regular use.

Counselling the patient

• Take it as early as possible in an attack, but limit how many days per month you treat to avoid rebound headaches.
• Report chest tightness, jaw or arm pain, or any indigestion, black stools or breathlessness.
• Take with food and avoid other NSAIDs or other triptans.

Evidence & guidelines

Combined sumatriptan-naproxen provides greater and more sustained migraine relief than either component alone in randomised trials.