Commonly Used Triptans and Their Dosages for Acute Migraine Treatment
The most commonly used triptans include sumatriptan (25-100 mg), rizatriptan (5-10 mg), eletriptan (20-80 mg), zolmitriptan (2.5-5 mg), naratriptan (2.5 mg), almotriptan (12.5 mg), and frovatriptan (2.5 mg), with sumatriptan 50-100 mg and rizatriptan 10 mg offering the best balance of efficacy and tolerability for most patients. 1, 2, 3
Sumatriptan (First-Generation Triptan)
Available doses: 25 mg, 50 mg, and 100 mg tablets 1
- Standard dosing: Single dose of 25 mg, 50 mg, or 100 mg 1
- Repeat dosing: A second dose may be taken only if some response to the first dose was observed, separated by at least 2 hours 1
- Maximum daily dose: 200 mg in 24 hours 1
- Optimal dose selection: The 50 mg dose offers the best ratio of efficacy to tolerability, though many patients prefer or require the 100 mg dose 4, 3
- Hepatic impairment: Maximum single dose should not exceed 50 mg in patients with mild to moderate hepatic impairment 1
- Efficacy data: 100 mg sumatriptan provides 59% headache response at 2 hours and 29% pain-free rate at 2 hours 3
Rizatriptan (High-Efficacy Option)
Available doses: 5 mg and 10 mg tablets, including orally disintegrating tablets (Maxalt MLT) 2
- Standard dosing: 10 mg is the preferred dose for optimal efficacy 3
- Repeat dosing: Can be taken every two hours as needed 2, 5
- Maximum daily dose: 30 mg 5
- Special formulation advantage: Orally disintegrating tablets are beneficial when nausea/vomiting are present 2
- Efficacy advantage: 10 mg rizatriptan shows better efficacy and consistency compared to 100 mg sumatriptan, with similar tolerability 3
- Contraindications: Concurrent use with ergotamine derivatives, use within 24 hours of another triptan, hemiplegic or basilar migraine, coronary artery disease, MAOIs, impaired hepatic function, and pregnancy 2
Eletriptan (Dose-Dependent Efficacy)
Available doses: 20 mg, 40 mg, and 80 mg 6, 3
- Standard dosing: 40 mg is commonly used, with 80 mg for patients requiring higher efficacy 3
- Efficacy profile: 80 mg eletriptan shows better efficacy than 100 mg sumatriptan but lower tolerability; 40 mg shows similar results to sumatriptan 100 mg 3
- CYP3A4 interaction: Should not be used within at least 72 hours of treatment with potent CYP3A4 inhibitors 6
- Common adverse events: Asthenia, nausea, dizziness, and somnolence are dose-related 6
Other Available Triptans
Zolmitriptan
- Doses: 2.5 mg and 5 mg 7, 3
- Efficacy: 2.5 mg zolmitriptan provides 32% therapeutic gain, very similar to sumatriptan 100 mg 7, 3
Naratriptan
- Dose: 2.5 mg 7, 3
- Profile: Lower efficacy (22% therapeutic gain) but better tolerability and tendency toward less headache recurrence 7, 3
- Half-life: Longer than sumatriptan (26-30 hours) 7
Almotriptan
- Dose: 12.5 mg 3
- Profile: Similar 2-hour efficacy to sumatriptan 100 mg but better overall results and provides highest likelihood of consistent success 3
Frovatriptan
Critical Prescribing Framework
Frequency limitation: Triptans must be limited to no more than twice per week (approximately 8-9 treatment days per month) to prevent medication-overuse headache 8
Trial period: Patients should try a triptan for 2-3 migraine episodes before determining effectiveness 2, 8
Switching strategy: If one triptan is ineffective after appropriate dosing, switching to another triptan is recommended 2, 8
Combination approach: If a triptan provides insufficient relief, adding an NSAID or acetaminophen rather than increasing triptan frequency is recommended 8
Common Pitfalls
- Medication-overuse headache: Using triptans more than twice weekly can transform episodic migraine into chronic daily headache 8
- Inadequate trial: Abandoning a triptan after only one use without trying it for 2-3 episodes 2, 8
- Chest symptoms: Chest pressure, tightness, and throat tightness are common side effects generally not associated with myocardial ischemia, though high-risk patients require cardiac evaluation 2, 1