What is the maximum dose of sumatriptan for an adult with migraines?

Maximum Sumatriptan Dosing for Acute Migraine

The maximum daily dose of sumatriptan varies by route: 200 mg/24 hours for oral, 12 mg/24 hours for subcutaneous, and 40 mg/24 hours for intranasal administration. 1, 2

Route-Specific Maximum Dosing

Oral Sumatriptan

• Maximum daily dose: 200 mg in 24 hours 1, 2
• Individual doses: 25 mg, 50 mg, or 100 mg 1
• Minimum interval between doses: 2 hours 1
• Doses of 50 mg and 100 mg provide greater effect than 25 mg, though 100 mg may not be significantly better than 50 mg 1

Subcutaneous Sumatriptan

• Maximum daily dose: 12 mg in 24 hours 2, 3
• Standard dose: 6 mg, which may be repeated once after 1 hour if needed 2
• Provides fastest relief (within 15 minutes) with highest efficacy (70-82% response rate) 2

Intranasal Sumatriptan

• Maximum daily dose: 40 mg in 24 hours 2, 3
• Dose range: 5-20 mg, which may be repeated after 2 hours 2

Critical Monthly Frequency Limits

To prevent medication overuse headache, limit sumatriptan use to no more than 10 days per month. 2 This is a lower threshold than for NSAIDs and represents a critical safety consideration.

• Use no more than twice per week to avoid transforming episodic migraine into chronic daily headache 4
• This equates to approximately 8-9 treatment days per month 4
• The safety of treating more than 4 headaches in a 30-day period has not been established by the FDA 1

Hepatic Impairment Dosing

In patients with mild to moderate hepatic impairment, the maximum single oral dose should not exceed 50 mg. 1

Managing Inadequate Response

Before Increasing Frequency

• Patients must try sumatriptan for 2-3 separate headache episodes before determining effectiveness 2, 3
• If 100 mg oral sumatriptan provides insufficient relief, add an NSAID (naproxen, ibuprofen, or diclofenac) or acetaminophen rather than increasing triptan dose or frequency 2, 4
• Combination therapy (triptan plus NSAID) is more effective than increasing triptan dose alone 2

Switching Triptans

• If inadequate response occurs after appropriate dosing for 2-3 attacks, switch to another triptan (almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, or zolmitriptan) 2, 3
• Different triptans work for different patients even when one fails 2

Headache Recurrence Management

• Approximately 40% of patients experience headache recurrence within 8-12 hours after initial response 2
• A second dose can be administered following minimum interval requirements (2 hours for oral, 1 hour for subcutaneous, 2 hours for intranasal) 2, 1

Critical Contraindications and Drug Interactions

Sumatriptan is absolutely contraindicated within 24 hours of another triptan or ergotamine/dihydroergotamine. 2, 3

Additional contraindications include:

• Coronary artery disease, previous myocardial infarction, or Prinzmetal angina 2
• Hemiplegic or basilar migraine 2, 3
• Uncontrolled hypertension 2
• Current MAOI use 2, 3

Optimal Timing Strategy

Administer sumatriptan early in the headache phase when pain is still mild for better outcomes. 2 Taking medication early provides more effective relief than waiting until pain becomes moderate or severe.

Common Prescribing Pitfall

The most critical error is allowing patients to use sumatriptan too frequently, which risks medication overuse headache development. 2 Patients must explicitly understand the 10-day-per-month limit when receiving their prescription. 2