Can sumatriptan be used in a patient with acute hepatitis?/nThe question concerns a middle-aged man

Fråga: Can sumatriptan be used in a patient with acute hepatitis?

The question concerns a middle-aged man with acute hepatitis and migraine. He has increased liver enzymes, but his prothrombin value is normal. Presently, he takes no other drugs.

Sammanfattning: Liver disease may lead to higher oral bioavailability of sumatriptan and a dose reduction should therefore be considered when the drug is administered per os.

Svar: A question concerning the use of sumatriptan in a patient with biliary cirrhosis has previously been answered in Drugline (1). Sumatriptan undergoes extensive first pass metabolism, presumably by the enzyme monoamine oxidase-A, which is present in both the intestinal wall and the liver. Oral bioavailability of sumatriptan is therefore low and variable. Acute and chronic liver disease may influence the metabolising capacity of the liver, thus leading to increased bioavailability and slower elimination of sumatriptan. It should be noted that the recommended oral dose of 100 mg stated in FASS (2) normally gives a higher systemic drug exposure than a 6 mg subcutaneous dose, and that a 50 mg oral dose is often sufficient for pain relief.

A Medline search has not revealed any reports concerning liver disease caused by sumatriptan. The files of the Swedish Adverse Drug Reactions Advisory Committee (SADRAC) contain two reports (among a total of 134) concerning possible hepatic side effects of sumatriptan: a 36-year-old woman with increased liver enzyme levels (ASAT 1.6, ALAT 7.0, GT 3.8 and ALP 9.9) after 8 injections of sumatriptan within 20 days, and a 50-year-old woman who had symptoms of biliary spasm after intake of an oral 50 mg dose on two occasions. 1 Drugline nr 13877 (year 1996) (enclosed) 2 FASS 1997 (The Swedish catalogue ofapproved medical products)