What is the dosage and frequency for sumatriptan (Imitrex) for migraine treatment?

Sumatriptan Dosing for Migraine Treatment

For sumatriptan 100 mg tablets, the sig should read: "Take one tablet (100 mg) by mouth at onset of migraine. May repeat after 2 hours if needed. Do not exceed 200 mg in a 24-hour period." 1

Dosing Guidelines for Sumatriptan Tablets

• Starting dose options:

  • 100 mg orally at onset of migraine symptoms
  • Alternative doses: 25 mg or 50 mg orally
  • Note: 50 mg and 100 mg doses may provide greater effect than 25 mg, but 100 mg may not provide greater benefit than 50 mg 1

• Repeat dosing:

  • If migraine persists after 2 hours or returns after initial improvement, a second dose may be administered
  • Must wait at least 2 hours between doses
  • Maximum daily dose: 200 mg in a 24-hour period 1

• After sumatriptan injection:

  • If migraine returns following initial treatment with sumatriptan injection, tablets (up to 100 mg/day) may be given
  • Must maintain interval of at least 2 hours between tablet doses 1

Special Considerations

• Hepatic impairment:

  • For patients with mild to moderate hepatic impairment, maximum single dose should not exceed 50 mg 1, 2
  • Use with caution or avoid in severe hepatic impairment 2

• Treatment frequency:

  • Safety of treating more than 4 headaches in a 30-day period has not been established 1, 2
  • Patients should try medication for 2-3 headache episodes before determining effectiveness 2

Efficacy and Clinical Pearls

• Oral sumatriptan 100 mg achieves headache relief in 50-67% of patients at 2 hours 3
• Patient preference studies show 35% prefer 100 mg, 31% prefer 50 mg, and 25% prefer 25 mg 4
• Higher doses (50 mg and 100 mg) are significantly more likely to provide headache relief at 2,3, and 4 hours compared to 25 mg 4
• Treating migraine during mild pain phase provides better outcomes than waiting until pain is moderate or severe 2

Contraindications

• Sumatriptan is contraindicated in:
  • Ischemic heart disease
  • Coronary artery disease
  • Uncontrolled hypertension
  • Hemiplegic or basilar migraine
  • Use within 24 hours of another triptan or ergotamine-containing medication
  • Use of MAO inhibitors
  • Severe hepatic impairment
  • Pregnancy 2, 5

Common Adverse Events

• Most adverse events are transient
• Oral administration: nausea, vomiting, malaise, fatigue, dizziness
• Chest symptoms (tightness and pressure) occur in 3-5% of patients 5, 6

Remember that approximately 40% of patients who initially respond to oral sumatriptan may experience headache recurrence within 24 hours, but most respond well to a second dose (following the 2-hour interval requirement) 6.