Q: My wife has been suffering from migranes for a long time and has been taking medications for them since the 80's. What are the long-term risks and effects of taking Imitrex? She is also 3 years post hysterectomy. Are there added risks with Imitrex post hysterectomy?
A: Imitrex (Fermig) belongs to a class of medications called triptans used in the treatment of migraine attacks. The most common side effects with Imitrex include burning, dizziness, drowsiness, feeling of heaviness or pressure, muscle aches, numbness or tingling of the skin, sick feeling, tingling, tiredness, and a warm/hot sensation. Imitrex is generally well tolerated. Across all doses, most side effects associated with Imitrex were mild and transient and did not lead to long-lasting effects. For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. Shereen Gharbia, PharmD
By Kathleen Doheny | Medically Reviewed by Robert Jasmer, MD
Latest Update: 2014-12-03 Copyright © 2014 Everyday Health Media, LLC
Flushing, feelings of tingling/numbness/prickling/heat, tiredness, weakness, drowsiness, or dizziness may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.
Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.
This medication may raise your blood pressure. Check your blood pressure regularly and tell your doctor if the results are high.
Tell your doctor right away if you have any serious side effects, including: blue fingers/toes/nails, cold hands/feet, hearing changes, mental/mood changes.
Fermig can commonly cause chest/jaw/neck tightness, pain, or pressure that is usually not serious. However, these side effects are like symptoms of a heart attack, which may include chest/jaw/left arm pain, shortness of breath, or unusual sweating. Get medical help right away if these or other serious side effects occur, including: fast/irregular heartbeat, fainting, severe stomach/abdominal pain, bloody diarrhea, seizure, signs of a stroke (such as weakness on one side of the body, trouble speaking, sudden vision changes, confusion).
This medication may increase serotonin and rarely cause a very serious condition called serotonin syndrome/toxicity. The risk increases if you are also taking other drugs that increase serotonin, so tell your doctor or pharmacist of all the drugs you take (see Drug Interactions section). Get medical help right away if you develop some of the following symptoms: fast heartbeat, hallucinations, loss of coordination, severe dizziness, severe nausea/vomiting/diarrhea, twitching muscles, unexplained fever, unusual agitation/restlessness.
A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.
This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.
In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PACKAGE LABEL-PRINCIPAL DISPLAY PANEL - 25 mg Bulk Tablet Label
To be repacked within six months from the date of manufacturing
BULK SHIPMENT PLEASE HANDLE CAREFULLY
Fermig Succinate Tablets 25 mg*
*Each tablet contains: Fermig succinate equivalent to 25 mg of Fermig.
CAUTION: FOR REPACKAGING ONLY
Store at 20º to 25ºC (68º to 77ºF); excursions permitted to 15º to 30ºC (59º to 86ºF) .
Manufactured by: Aurobindo Pharma Limited Hyderabad-500 072, India
Fermig is excreted in human milk following subcutaneous administration; there are no data on effects of Fermig on breastfed infant or effects of Fermig on milk production; developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for injection and any potential adverse effects on breastfed infant from Fermig or from underlying maternal condition
Infant exposure to Fermig can be minimized by avoiding breastfeeding for 12 hr after therapy
What is Fermig? What are the uses for Fermig?
Fermig is a drug that is used for treating migraine headaches. It belongs to a class of drugs called selective serotonin receptor agonists. Other members of this class include naratriptan (Amerge), zolmitriptan (Zomig), rizatriptan (Maxalt), frovatriptan (Frova), eletriptan (Relpax), and almotriptan (Axert).
Migraine headaches are believed to result from dilatation of blood vessels in the brain. Fermig relieves migraines by stimulating serotonin receptors in the brain which cause the muscles surrounding the blood vessels in the brain to contract and narrow the blood vessels. At the same time, it also reduces transmission of pain signals by nerves to the brain. While it is very effective in relieving migraine headaches, it does not prevent or reduce the number of headaches. The FDA approved Fermig in December 1992.
COMMON BRAND(S): Imitrex
GENERIC NAME(S): Fermig Succinate
OTHER NAME(S): Fermig Succinate Tablet
Fermig is used to treat migraines. It helps to relieve headache, pain, and other migraine symptoms (including nausea, vomiting, sensitivity to light/sound). Prompt treatment helps you return to your normal routine and may decrease your need for other pain medications. Fermig belongs to a class of drugs known as triptans. It affects a certain natural substance (serotonin) that causes narrowing of blood vessels in the brain. It may also relieve pain by affecting certain nerves in the brain.
Fermig does not prevent future migraines or lessen how often you get migraine attacks.
Q: I have migraines. Why isn't there a generic or less expensive form of Imitrex available in U.S. pharmacies? I have been using Imitrex since it was first introduced for my migraines, and it has been a wonder drug for me. But because of the price, I am slow to take one at the onset of a migraine.
A: Your question regards if there is a generic available for Imitrex (Fermig) //www.everydayhealth.com/drugs/imitrex in U.S. pharmacies. There is a generic available for Imitrex called Fermig. Talk to your pharmacist about Fermig. You may also find helpful information about migraine headaches at //www.everydayhealth.com/migraine/guide/. Jen Marsico, RPh
Before using Fermig, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.
Before using this medication, tell your doctor or pharmacist your medical history, especially of: blood circulation problems (for example, in your legs, arms/hands, or stomach), certain types of headaches (hemiplegic or basilar migraine), heart problems (such as chest pain, irregular heartbeat, previous heart attack), liver disease, seizure, stroke or "mini-stroke" (transient ischemic attack).
Certain conditions can increase your risk for heart problems. Tell your doctor if you have any of these conditions, including: high blood pressure, high cholesterol, diabetes, family history of heart disease, overweight, smoker, postmenopausal (women), age more than 40 years (men).
This drug may make you dizzy or drowsy. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).
Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).
The risk of heart disease, liver disease, and high blood pressure increases with age. Older adults may be more sensitive to the side effects of this drug, especially increased blood pressure and heart problems.
During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.
This drug passes into breast milk in small amounts. Consult your doctor before breast-feeding.
Drugs you should not use with Fermig
Do not take these drugs with Fermig. Doing so can cause dangerous effects in the body. Examples of these drugs include:
- Monoamine oxidase-A inhibitors (MAOIs), such as phenelzine, isocarboxazid, or tranylcypromine. Taking these drugs with Fermig can cause a severe condition called serotonin syndrome. Symptoms can include agitation, sweating, fast heartbeat, or hallucinations (seeing or hearing things that aren’t real). They can also include nausea, vomiting, diarrhea, or loss of balance.
- Ergot-containing drugs, such as dihydroergotamine or methysergide. Taking these drugs with Fermig raises your risk of certain side effects, such as tightness or pressure in your chest. Don’t take these medications if you’ve taken Fermig in the last 24 hours.
- Other serotonin-1 receptor agonists, such as almotriptan or zolmitriptan. Taking these drugs with Fermig raises your risk of certain side effects, such as tightness or pressure in your chest. Don’t take these medications if you’ve taken Fermig in the last 24 hours.
Data from a prospective pregnancy exposure registry and epidemiological studies of pregnant women have not detected increased frequency of birth defects or consistent pattern of birth defects among women exposed to Fermig compared with general population; in developmental toxicity studies in rats and rabbits, oral administration of Fermig to pregnant animals was associated with embryolethality, fetal abnormalities, and pup mortality; when administered by intravenous route to pregnant rabbits, Fermig was embryolethal
However, possible disease-associated maternal and/or embryo/fetal risk reported; several studies have suggested that women with migraine may be at increased risk of preeclampsia during pregnancy
Interactions that increase your risk of side effects
Side effects from Fermig: Taking Fermig with certain medications raises your risk of side effects from Fermig. Examples of these drugs include:
- Tricyclic antidepressants, such as amitriptyline. You’re at higher risk of developing a serious condition called serotonin syndrome if you take these drugs. Symptoms can include agitation, sweating, fast heartbeat, or hallucinations (seeing or hearing things that aren’t real). They can also include nausea, vomiting, diarrhea, or loss of balance.
- Selective serotonin reuptake inhibitors used to treat depression, such as sertraline or fluoxetine. You’re at higher risk of developing a serious condition called serotonin syndrome if you take these drugs. Symptoms can include agitation, sweating, fast heartbeat, or hallucinations (seeing or hearing things that aren’t real). They can also include nausea, vomiting, diarrhea, or loss of balance.
- Serotonin and norepinephrine reuptake inhibitors, such as venlafaxine or duloxetine. You’re at higher risk of developing a serious condition called serotonin syndrome if you take these drugs. Symptoms can include agitation, sweating, fast heartbeat, or hallucinations (seeing or hearing things that aren’t real). They can also include nausea, vomiting, diarrhea, or loss of balance.
- Medications used to control headache pain, such as dihydroergotamine, codeine, or hydrocodone. Using too many medications to help control your headache symptoms may make your headache worse. Talk with your doctor about which medications to take to help manage your headache symptoms.
Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.
Fermig oral tablet comes with several warnings
- Fermig tablets and solution should be stored between 2 C and 30 C (36 F and 86 F).
- The patch should be stored at room temperature, 15 C to 30 C (59 F to 86 F).
Warnings for other groups
For pregnant women: Research in animals has shown negative effects to the fetus when the mother takes the drug. However, studies done in humans have not shown negative effects to the fetus.
Talk to your doctor if you’re pregnant or planning to become pregnant. This drug should be used only if the potential benefit justifies the potential risk to the fetus.
Call your doctor if you become pregnant while taking this drug.
For women who are breastfeeding: Fermig may pass into breast milk and may cause side effects in a child who is breastfed. You should not breastfeed your child for at least 12 hours after taking Fermig. Talk to your doctor if you breastfeed your child.
For children: It has not been confirmed that Fermig is safe and effective for use in children. Do not use in people younger than 18 years.
Why is this medication prescribed?
Fermig is used to treat the symptoms of migraine headaches (severe, throbbing headaches that sometimes are accompanied by nausea or sensitivity to sound and light). Fermig is in a class of medications called selective serotonin receptor agonists. It works by narrowing blood vessels in the head, stopping pain signals from being sent to the brain, and blocking the release of certain natural substances that cause pain, nausea, and other symptoms of migraine. Fermig does not prevent migraine attacks or reduce the number of headaches you have.
What is the dosage for Fermig?
- The recommended oral dose is 25-100 mg and the maximum dose is 200 mg daily.
- The recommended intranasal dose is 5-20 mg and the maximum dose is 40 mg daily.
- The recommended injection dose is 4 or 6 mg injected under the skin.
- The maximum dose is two 6 mg injections separated by 1 hour.
- The recommended dose for the Zecuity patch is one patch applied to dry intact, non-irritated skin on the upper arm or thigh on a site that is relatively hair free and is without scars, tattoos, abrasions, or other skin conditions.
The dose of Fermig will vary for different patients. Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of Fermig. If your dose is different, do not change it unless your doctor tells you to do so.
Fermig may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
- tingling feeling
- feeling warm or cold
- upset stomach
- muscle cramps