Clinical Implications for Breath-Powered Powder Sumatriptan Intranasal Treatment


  • Funding: The research presented in this paper was funded by OPTINOSE, Inc.
  • Conflict of Interest:Dr. Tepper receives grants/research support from Allergan, ATI, BristolMyerSquibb, GSK, Merck, NuPathe, OPTINOSE, and Zogenix. These grants do not go to him personally, and do not count toward his salary at Cleveland Clinic.
  • All amounts received are <$10,000/year per Cleveland Clinic Policy and are listed on the Cleveland Clinic website.
  • In the last 12 months, he has served as a consultant for Allergan, ATI, MAP, Nautilus, NuPathe, Pfizer, and Zogenix.
  • In the last 12 months, he has served on the speakers bureau for Allergan, MAP, Nautilus, and Zogenix.
  • In the last 12 months, he served on advisory boards for Allergan, ATI, MAP, Nautilus, NuPathe, USWorldMeds, and Zogenix.
  • Dr. Tepper holds stock options in ATI.

Address all correspondence to S. J. Tepper, Cleveland Clinic, Headache Center, C21, 9500 Euclid Ave., Cleveland, OH 44195, USA.


The acute treatment of migraine requires matching patient need to drug and formulation. In particular, nausea and vomiting, quick time to peak intensity, and the common gastroparesis of migraineurs, all call for a variety of non-oral formulations for treatment of attacks. A novel breath-powered powder sumatriptan intranasal treatment offers an improvement, at least in pharmacokinetics, over conventional liquid nasal sumatriptan spray.

The device for delivery in this breath-powered nasal sumatriptan uses natural nose anatomy to close the soft palate and propel the sumatriptan high up in the nasal cavity on one side with bidirectional airflow coming out the other side. This approach has the potential to reduce adverse events and improve efficacy. Phase 3 data on this system are in press at the time of this writing and results appear promising.

The clinical role for a fast acting non-oral nasal formulation will be in those for whom tablets are bound to fail, that is, in the setting of nausea and vomiting or when the time to central sensitization, allodynia, and disabling migraine is too short for the patient to respond to a tablet. This review provides a clinical perspective on the breath-powered powder sumatriptan intranasal treatment.