What is the recommended dosage of triptans (serotonin receptor agonists) for migraine treatment?

Recommended Triptan Dosages for Migraine Treatment

The recommended triptan dosages for acute migraine treatment vary by specific medication, with sumatriptan 50-100 mg, rizatriptan 5-10 mg, naratriptan 1-2.5 mg, and zolmitriptan 2.5-5 mg being the standard oral doses, with each medication having specific maximum daily limits. 1

Specific Triptan Dosing Guidelines

Sumatriptan

• Oral: 25-100 mg, may repeat after 2 hours if needed, maximum 200 mg daily 2
• Subcutaneous: 6 mg, may repeat after 1 hour, maximum 12 mg daily 3
• Intranasal: 5-10 mg (1-2 sprays) in one nostril, may repeat after 2 hours, maximum 40 mg daily 3, 4

Rizatriptan

• 5-20 mg orally every two hours, maximum 30 mg daily 1
• Available as standard tablets or orally disintegrating tablets (Maxalt MLT), beneficial when nausea/vomiting are present 5

Naratriptan

• 1.0-2.5 mg orally every four hours, maximum 5 mg daily 1
• Has the longest half-life among triptans, which may decrease chance of recurrence headaches 1

Zolmitriptan

• 2.5-5.0 mg orally every two hours, maximum 10 mg per 24 hours 1

Efficacy and Selection Principles

• Patients should try a triptan for 2-3 headache episodes before abandoning that line of therapy 1, 5
• If one triptan is ineffective, a different triptan should be tried 1, 3
• The 50 mg dose of sumatriptan appears to offer the best ratio of efficacy to tolerability, though many patients prefer or require the 100 mg dose 6, 7
• Higher doses may provide greater effect but also increased risk of adverse reactions 2, 8

Route of Administration Considerations

• When significant nausea and/or vomiting are present, non-oral routes (subcutaneous, intranasal) or orally disintegrating tablets may be preferable 1, 5
• Subcutaneous sumatriptan reaches peak concentration faster than other migraine-specific medications (approximately 15 minutes) 1
• Oral rizatriptan reaches peak concentration in 60-90 minutes, compared with 2-3 hours for most other triptans 1

Important Contraindications

• Triptans should not be used with ergotamine derivatives, MAOIs, or within 24 hours of another triptan 1, 3
• Contraindicated in patients with hemiplegic or basilar migraine, coronary artery disease, and pregnancy 1, 4
• In patients with mild to moderate hepatic impairment, the maximum single dose of sumatriptan should not exceed 50 mg 2

Common Adverse Effects

• Common side effects include chest pressure/heaviness, throat tightness, nausea, warmth, dizziness, and fatigue 1, 3
• Adverse events are more common with higher doses (e.g., sumatriptan 100 mg vs. 50 mg or 25 mg) 9, 8
• Subcutaneous administration can cause injection site reactions in approximately 30% of patients 3

Managing Recurrence

• If migraine returns after initial improvement, a second dose may be administered (at least 2 hours after the first dose for most triptans) 2
• Recurrence rates are similar across different doses of the same triptan, though time to recurrence may increase with higher doses 7
• The safety of treating more than 4 headaches in a 30-day period has not been established for most triptans 2