What is the recommended dose of Sumitriptan (sumatriptan) for migraine headaches in adults?

Recommended Dosing of Sumatriptan for Migraine Headaches in Adults

The recommended dose of oral sumatriptan for migraine headaches in adults is 25 mg, 50 mg, or 100 mg, with a maximum daily dose of 200 mg in a 24-hour period. 1

Oral Administration

• The FDA-approved dosing for oral sumatriptan is 25 mg, 50 mg, or 100 mg 1
• Doses of 50 mg and 100 mg may provide greater effect than 25 mg, but 100 mg may not provide greater effect than 50 mg 1
• If migraine has not resolved after 2 hours or returns after transient improvement, a second dose may be administered at least 2 hours after the first dose 1
• Maximum daily dose should not exceed 200 mg in a 24-hour period 1
• In patients with mild to moderate hepatic impairment, the maximum single dose should not exceed 50 mg 1

Alternative Routes of Administration

• Subcutaneous: 6 mg, which can be repeated after one hour, with a maximum daily dose of 12 mg per 24 hours 2
• Intranasal: 5-10 mg (one to two sprays) in one nostril, which can be repeated after 2 hours, with a maximum daily dose of 40 mg per day 2

Efficacy Considerations

• The 100 mg oral dose has shown better efficacy than 50 mg for pain-free and headache relief at two hours 3
• For headache relief at 2 hours, Numbers-Needed-to-Treat (NNTs) were 3.4,3.2, and 3.4 for sumatriptan 100 mg, 50 mg, and 25 mg, respectively 4
• Treating early during the mild pain phase provides better outcomes than treating established attacks with moderate or severe pain intensity 3
• Patients should try a medication for 2-3 headache episodes before abandoning that line of therapy 5

Combination Therapy

• If patients use an adequate dose of sumatriptan and still do not have sufficient pain relief, consider combining with an NSAID or acetaminophen 6
• Current guidelines recommend adding a triptan to an NSAID or acetaminophen when monotherapy does not provide sufficient pain relief 6

Important Contraindications

• Sumatriptan should not be used with ergotamine, MAOIs, or within 24 hours of another triptan 2
• Contraindicated in patients with hemiplegic or basilar migraine, pregnancy, impaired hepatic function, or coronary artery disease 2

Common Adverse Effects

• Adverse events are more common with sumatriptan 100 mg than with placebo 4
• Common side effects include nausea, warmth, vomiting, vertigo, malaise, headache, chest pressure and heaviness 5
• Subcutaneous administration can cause injection site reactions in approximately 30% of patients 2
• If the patient experiences unpleasant sensory disturbances with sumatriptan, trying a different triptan may be beneficial 5

Managing Treatment Failure

• If inadequate response after dose optimization, consider switching to another triptan (almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, or zolmitriptan) 6, 5
• Consider using a nonoral triptan and an antiemetic in people having severe nausea or vomiting 6
• Be aware that patients who do not tolerate or have inadequate response to a recommended migraine treatment may respond to another within the same drug class 6