What is the recommended dosage and usage of Sumatriptan (sumatriptan) for treating migraine attacks?

Sumatriptan Dosage and Usage for Migraine Attacks

The recommended dosage of sumatriptan for treating migraine attacks is 50 mg orally as the initial dose, with a maximum daily dose of 200 mg in a 24-hour period. 1

Dosage Options by Route of Administration

Oral Administration

• Initial dose: 50 mg
• Alternative doses: 25 mg or 100 mg
  • 100 mg may provide greater effect than 50 mg, but with increased risk of adverse reactions
  • 25 mg may be appropriate for patients with mild to moderate hepatic impairment 1
• If migraine persists after 2 hours or returns after initial improvement, a second dose may be administered (at least 2 hours after first dose)
• Maximum daily dose: 200 mg in a 24-hour period 1

Subcutaneous Administration

• 6 mg subcutaneously for:
  • Severe attacks
  • Attacks with significant nausea/vomiting
  • Attacks requiring rapid relief 2
• Subcutaneous administration provides the most rapid pain relief compared to other routes 3

Treatment Algorithm

1. For mild to moderate attacks without significant nausea/vomiting:

   • Start with 50 mg oral sumatriptan
   • If inadequate relief after 2 hours, may take a second dose (maintaining minimum 2-hour interval)
   • If 50 mg consistently ineffective across multiple attacks, consider increasing to 100 mg

2. For severe attacks or attacks with significant nausea/vomiting:

   • Consider 6 mg subcutaneous sumatriptan for faster onset of action
   • Non-oral routes recommended when nausea/vomiting is a significant component 4, 2

3. For patients with hepatic impairment:

   • Maximum single dose should not exceed 50 mg 1

Efficacy Considerations

• Taking sumatriptan early in an attack (while pain is still mild) provides better outcomes than waiting until pain is moderate or severe 4, 3
• Subcutaneous administration (6 mg) provides relief in approximately 59% of patients within 2 hours compared to 15% with placebo 3
• Oral administration (50 mg) provides complete pain relief in about 28% of patients within 2 hours compared to 11% with placebo 3

Important Limitations and Precautions

• Do not use during migraine aura phase 4, 5
• Do not use more than 9 days per month to avoid medication overuse headache 2
• Contraindicated in patients with:
  • Ischemic heart disease
  • Previous myocardial infarction
  • Prinzmetal (variant) angina
  • Uncontrolled hypertension 5
• Do not use concurrently with ergotamine-containing medications or other vasoconstrictive substances 5

Managing Headache Recurrence

• Approximately 40% of patients may experience headache recurrence within 24 hours after initial response 5
• For recurrence, a second dose of sumatriptan may be administered (maintaining minimum 2-hour interval between doses)
• Consider combining with fast-acting NSAIDs (naproxen sodium, ibuprofen lysine, diclofenac potassium) for recurrent headaches 4
• The safety of treating more than 4 headaches in a 30-day period has not been established 1

By following these dosage recommendations and considering the patient's specific migraine characteristics, sumatriptan can provide effective relief for acute migraine attacks while minimizing adverse effects.