From the Guidelines
Sumatriptan should be prescribed at a dose of 6 mg subcutaneously, repeated in one hour if necessary, with a maximal dosage of 12 mg per 24 hours, or 25 to 100 mg orally every two hours, with a maximal dosage of 200 mg per day, as the most effective treatment for acute migraine headaches. According to the study published in the American Family Physician 1, sumatriptan is a 5-HT 1 receptor-specific agonist that is effective in 70 to 82 percent of patients. The subcutaneously injectable form of sumatriptan reaches peak blood concentrations faster than any other migraine-specific medications, in approximately 15 minutes. The oral form of sumatriptan can be taken every two hours, with a maximum daily dose of 200 mg. It is essential to note that sumatriptan is contraindicated in patients with ergotamine, MAOIs, use within 24 hours of another triptan, hemiplegic or basilar migraine, pregnancy, impaired hepatic function, as prophylactic therapy, and CAD. Common adverse reactions include nausea, warmth, vomiting, vertigo, malaise, headache, injection site reactions, and chest pressure and heaviness.
Some key points to consider when prescribing sumatriptan include:
- Starting treatment at the first sign of migraine symptoms
- Limiting the dose to the maximum daily dose to avoid overuse
- Considering preventive treatments if using frequently
- Avoiding use in patients with certain medical conditions, such as coronary artery disease and uncontrolled hypertension
- Monitoring for potential side effects, such as chest tightness and flushing.
It is crucial to consult current pharmacologic resources, such as the Physician’s Desk Reference, before prescribing sumatriptan, as the information provided may not be all-inclusive in treatment protocols, contraindications, or adverse reactions 1.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION 2. 1 Dosing Information The recommended dose of sumatriptan tablets is 25 mg, 50 mg, or 100 mg. The recommended dose of sumatriptan is:
- 25 mg
- 50 mg
- 100 mg The maximum daily dose is 200 mg in a 24-hour period 2.
From the Research
Sumatriptan Dose Information
- The recommended dosage of sumatriptan at the onset of migraine symptoms is 100 mg orally or 6 mg subcutaneously 3.
- For cluster headache, the recommended dosage is 6 mg sumatriptan subcutaneously 3.
- Oral sumatriptan has been shown to be effective in doses of 100 mg, 50 mg, and 25 mg, with the 100-mg dose providing significantly better pain-free response and headache relief at 2 hours 4.
- A study of 104 patients found that oral sumatriptan was effective in clinical practice at doses of 25 and 50 mg, with 40% of patients continuing therapy with 25-mg tablets and 53% being prescribed 50-mg tablets 5.
- Different sumatriptan formulations, including subcutaneous, intranasal, transdermal, oral, and suppository options, have different pharmacokinetic, efficacy, and adverse event profiles, and patients should use an attack-based treatment approach to balance speed of relief, efficacy, and tolerability 6.
Contraindications and Warnings
- Sumatriptan is contraindicated in patients with ischemic heart disease, previous myocardial infarction, Prinzmetal (variant) angina, and uncontrolled hypertension 3.
- Triptans, including sumatriptan, are contraindicated in cardiovascular disease patients and have warnings and precautions for those with cardiovascular risk factors 7.
- An analysis of real-world claims data found that approximately 20% of commercially insured US migraine patients have a cardiovascular condition that specifically contraindicates triptan treatment, and an additional 25% have two or more cardiovascular risk factors identified as warnings and precautions to triptans 7.