Sumatriptan Dosing for Migraine Treatment
The recommended dose of oral sumatriptan for migraine treatment is 50 mg initially, which may be increased to 100 mg if needed, with a maximum daily dose of 200 mg in a 24-hour period. 1
Dosing Options by Route of Administration
Oral Administration
- Initial recommended dose: 25 mg, 50 mg, or 100 mg 1
- 50 mg and 100 mg doses provide greater efficacy than 25 mg, though 100 mg may not provide additional benefit over 50 mg 1
- Maximum daily dose: 200 mg in a 24-hour period 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) 1
Subcutaneous Administration
- Recommended dose: 6 mg SC, which can be repeated after one hour 2
- Maximum daily dose: 12 mg per 24 hours 2
- Provides fastest relief (peak blood concentration in approximately 15 minutes) 2
- Most effective route with 59% of patients achieving pain-free status at 2 hours 3
Intranasal Administration
- Recommended dose: 5-10 mg (one to two sprays) in one nostril 2
- May be repeated after 2 hours 2
- Maximum daily dose: 40 mg per day 2
Efficacy Considerations
- The 50 mg oral dose offers the best balance of efficacy and tolerability 4
- Subcutaneous administration provides more rapid pain relief than other routes 3
- Taking medication early when pain is mild is more effective than waiting until pain is moderate or severe 3
- Effectiveness rates for headache relief at 2 hours:
Special Dosing Considerations
- For patients with mild to moderate hepatic impairment, maximum single dose should not exceed 50 mg 1
- If a patient experiences unpleasant sensory disturbances with one triptan, trying a different triptan may be beneficial 5
- Patients should try a medication for 2-3 headache episodes before abandoning that line of therapy 2, 5
Important Contraindications
- Ergotamine use (do not use within 24 hours of each other) 2
- MAOIs 2
- Use within 24 hours of another triptan 2
- Hemiplegic or basilar migraine 2
- Pregnancy 2
- Impaired hepatic function (dose adjustment required) 2
- Coronary artery disease 2
Common Adverse Effects
- Oral administration: nausea, vomiting, malaise, fatigue, dizziness 6
- Subcutaneous administration: injection site reactions (in approximately 30% of patients), chest pressure and heaviness 2, 6
- Adverse events are generally mild to moderate and of short duration 3
- Higher incidence of adverse events with 100 mg (30%) compared to 50 mg (21%) and 25 mg (19%) 7
Clinical Pearls
- If using after sumatriptan injection, additional single tablets (up to 100 mg/day) may be given with an interval of at least 2 hours between doses 1
- The safety of treating more than 4 headaches in a 30-day period has not been established 1
- Recurrence rates are similar across different oral doses (33-38%), though higher doses may delay recurrence time 7
- Patient preference studies show that 35% prefer 100 mg, 31% prefer 50 mg, and 25% prefer 25 mg, with efficacy and speed of action being the main reasons for preferring higher doses 7