From the Guidelines
For migraine treatment, sumatriptan is typically prescribed at 50-100 mg orally at the onset of headache, with a maximum daily dose of 200 mg. According to the American College of Physicians guideline 1, the choice of a specific triptan, such as sumatriptan, should be based on individualized decision making, taking into consideration patient preferences on such factors as route of administration and cost. When prescribing sumatriptan, it is essential to ensure that patients are using the appropriate dosage and to consider increasing the dosage without exceeding the recommended maximum daily dose in patients who do not achieve sufficient pain relief. Some key points to consider when prescribing sumatriptan include:
- Starting with the lowest effective dose to minimize side effects
- Considering a second dose after 2 hours if symptoms return, but no more than 200 mg should be used within 24 hours
- Being aware of common side effects, such as chest tightness, flushing, dizziness, and fatigue
- Contraindications, including coronary artery disease, uncontrolled hypertension, hemiplegic or basilar migraine, and within 24 hours of using other triptans or ergot medications. It is also important to note that sumatriptan can be used in combination with an NSAID or acetaminophen for patients who do not achieve sufficient pain relief with a single medication 1.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION 2. 1 Dosing Information The recommended dose of sumatriptan tablets is 25 mg, 50 mg, or 100 mg. The recommended dosage of sumatriptan for migraine is 25 mg, 50 mg, or 100 mg.
- The dose can be repeated after 2 hours if the migraine has not resolved or returns after a transient improvement.
- The maximum daily dose is 200 mg in a 24-hour period.
- In patients with mild to moderate hepatic impairment, the maximum single dose should not exceed 50 mg 2
From the Research
Dosage of Sumatriptan for Migraine
The dosage of sumatriptan for migraine is as follows:
- Oral administration: 100mg, which has been shown to achieve relief of migraine headache in 50 to 67% of patients compared with 10 to 31% with placebo in controlled clinical trials 3
- Subcutaneous administration: 6mg, which has been shown to achieve headache relief in 70 to 80% of patients with migraine receiving sumatriptan compared with 18 to 26% of placebo recipients 3
Comparison with Other Dosages
- A dose of 12mg subcutaneously has been shown to have a similar response rate as 6mg, but with an increased incidence of adverse events 3
- There is no evidence to suggest that doses higher than 100mg orally or 6mg subcutaneously are more effective, and may increase the risk of adverse events
Adverse Events
- The most frequently reported adverse events following oral administration include nausea, vomiting, malaise, fatigue, and dizziness 3
- Injection site reactions, such as minor pain and redness, occur in approximately 40% of patients receiving subcutaneous sumatriptan 3
- Chest symptoms, such as tightness and pressure, occur in 3 to 5% of sumatriptan recipients, but have not been associated with myocardial ischemia except in a few isolated cases 3