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

Recommended Dosage and Usage of Sumatriptan for Migraine Attacks

The recommended dose of sumatriptan for treating migraine attacks is 50 mg orally for most patients, with a maximum daily dose of 200 mg in a 24-hour period. 1, 2

Dosing Options and Administration

• Oral administration:

  • 25 mg, 50 mg, or 100 mg tablets
  • 50 mg is the standard recommended dose for most patients 1
  • 100 mg may provide greater effect than 50 mg for some patients, but with potentially increased risk of adverse reactions 2
  • Maximum daily dose: 200 mg in a 24-hour period 2

• Subcutaneous administration:

  • 6 mg subcutaneously for severe attacks or when significant nausea/vomiting is present 1
  • Provides more rapid pain relief than other routes 3

• Timing considerations:

  • If migraine has not resolved 2 hours after initial dose, a second dose may be administered (at least 2 hours after first dose) 2
  • Taking medication early when pain is mild is more effective than waiting until pain becomes moderate or severe 3

Special Populations

• Hepatic impairment:
  • For patients with mild to moderate hepatic impairment, maximum single dose should not exceed 50 mg 2

Efficacy

• Oral sumatriptan 50 mg provides:

  • Complete pain relief at 2 hours in approximately 28% of patients (compared to 11% with placebo) 3
  • Headache relief (reduction from moderate/severe to mild/none) at 2 hours in significantly more patients than placebo (NNT 4.0) 4

• Subcutaneous sumatriptan 6 mg:

  • Provides relief of migraine headaches in 70-80% of patients within 1-2 hours 5
  • Most effective route for rapid pain relief 3

Limitations and Precautions

• Usage frequency limitations:

  • Sumatriptan should be limited to no more than 9 days per month to avoid medication overuse headache 1
  • Safety of treating more than 4 headaches in a 30-day period has not been established 2

• Contraindications:

  • Ischemic heart disease
  • Previous myocardial infarction
  • Prinzmetal (variant) angina
  • Uncontrolled hypertension 1, 5
  • Should not be given during migraine aura 5
  • Should not be given together with vasoconstrictive substances (e.g., ergotamines) or migraine prophylactics with similar properties (e.g., methysergide) 5

Common Side Effects

• Oral administration: Nausea, vomiting, malaise, fatigue, and dizziness 5, 6
• Subcutaneous administration: Injection site reactions (in approximately 30% of patients) 5
• Chest symptoms: Reported in 3-5% of patients, but rarely associated with myocardial ischemia 5
• Most adverse events are transient, mild to moderate in severity, and more common with subcutaneous administration and higher oral doses 3

Clinical Pearls

• Headache recurrence occurs in approximately 40% of patients who initially respond to oral or subcutaneous sumatriptan, usually within 24 hours 5
• A second dose of sumatriptan is effective for treating recurrent headaches 5, 6
• For cluster headaches, subcutaneous sumatriptan 6 mg provides relief within 15 minutes in 75% of patients 5
• Taking sumatriptan during the mild pain phase results in better outcomes than waiting until pain becomes moderate or severe 3