What is the recommended dose of sumatriptan (Imitrex) for adults?

Sumatriptan Dosing for Adults

The recommended dose of sumatriptan tablets for adults is 25 mg, 50 mg, or 100 mg, with 50 mg being the optimal starting dose for most patients due to its balance of efficacy and tolerability. 1

Dosing Guidelines by Administration Route

Oral Administration

• Starting dose: 50 mg
• Dose range: 25-100 mg
• Maximum daily dose: 200 mg in a 24-hour period
• Dosing interval: If migraine persists after 2 hours, a second dose may be administered (minimum 2-hour interval between doses)

Subcutaneous Administration

• Dose: 6 mg
• May repeat after 1 hour if needed
• Maximum daily dose: 12 mg per 24 hours

Intranasal Administration

• Dose: 5-10 mg (1-2 sprays) in one nostril
• May repeat after 2 hours if needed
• Maximum daily dose: 40 mg per day

Dose Selection Considerations

The 50 mg dose provides an optimal balance between efficacy and adverse effects for most patients 2, 1:

• 25 mg: May be sufficient for some patients and has fewer side effects
• 50 mg: Provides good efficacy with moderate side effect profile
• 100 mg: May provide greater efficacy than 50 mg for some patients, but with increased risk of adverse effects

Research shows that while the 100 mg dose may be more effective than 50 mg for pain-free response at 2 hours (NNT 4.7 vs 6.1), the 50 mg dose has a better tolerability profile 3.

Special Populations

Hepatic Impairment

• For mild to moderate hepatic impairment: Maximum single dose should not exceed 50 mg 1
• For severe hepatic impairment: Use with caution or avoid

Efficacy Considerations

Patient preference studies show:

• 35% of patients prefer 100 mg
• 31% prefer 50 mg
• 25% prefer 25 mg 4

Higher doses (50 mg and 100 mg) are preferred primarily due to greater efficacy and speed of action, while the 25 mg dose is associated with fewer adverse events 4.

Common Pitfalls and Caveats

1. Avoid exceeding maximum daily dose: Never exceed 200 mg in a 24-hour period

2. Respect minimum dosing intervals: Wait at least 2 hours between oral doses

3. Contraindications: Do not use with:

   • Ergotamine-containing medications
   • MAO inhibitors
   • Within 24 hours of another triptan
   • Hemiplegic or basilar migraine
   • Coronary artery disease
   • Uncontrolled hypertension
   • Pregnancy
   • Impaired hepatic function

4. Early treatment: Treating during the mild pain phase provides better outcomes than waiting until pain is moderate or severe 3

5. Medication overuse: The safety of treating more than 4 headaches in a 30-day period has not been established 1

6. Try before abandoning: Patients should try a medication for 2-3 headache episodes before abandoning that line of therapy 2