What is the standard dose of Imitrex (sumatriptan) for migraine?

Standard Dose of Imitrex (Sumatriptan) for Migraine

The standard oral dose of Imitrex is 50 mg or 100 mg, with 50 mg offering the optimal balance of efficacy and tolerability for most patients. 1

Oral Dosing Options

The FDA-approved oral doses are 25 mg, 50 mg, or 100 mg 1:

• 50 mg and 100 mg provide greater efficacy than 25 mg 1
• 100 mg may not provide significantly greater effect than 50 mg, but carries higher risk of adverse reactions 1
• The 50 mg dose appears to offer the best efficacy-to-tolerability ratio, though many patients prefer or require the 100 mg dose 2

Redosing Parameters

• If the migraine has not resolved by 2 hours or returns after transient improvement, a second dose may be given at least 2 hours after the first dose 1
• Maximum daily dose is 200 mg in a 24-hour period 1
• Patients should try the medication for 2-3 headache episodes before determining effectiveness 3, 4

Alternative Routes When Oral Route Inadequate

Subcutaneous administration:

• 6 mg dose, can be repeated after 1 hour 3, 4
• Maximum 12 mg per 24 hours 3, 4
• Provides faster relief (70-80% response by 1-2 hours) but causes injection site reactions in approximately 30% of patients 3, 5

Intranasal administration:

• 5-10 mg (one to two sprays) in one nostril, can be repeated after 2 hours 3, 4
• Maximum 40 mg per day 3, 4

Special Populations

Hepatic impairment:

• Maximum single dose should not exceed 50 mg in mild to moderate hepatic impairment 1

Optimization Strategies

• Combine with an NSAID or acetaminophen if adequate sumatriptan dose does not provide sufficient pain relief 3
• Consider nonoral triptan formulation with an antiemetic for patients with severe nausea or vomiting 3
• If inadequate response after dose optimization, switch to a different triptan (almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, or zolmitriptan) 3

Critical Contraindications

Do not use sumatriptan with: 3, 4

• Ergotamine derivatives or within 24 hours of another triptan
• MAOIs
• In patients with hemiplegic or basilar migraine
• Coronary artery disease or uncontrolled hypertension
• Pregnancy
• Impaired hepatic function

Common Adverse Effects

• Chest pressure and heaviness, nausea, warmth, vomiting, vertigo, malaise 3
• Monitor for medication overuse, which may lead to rebound headaches 3