Sumatriptan Dosage

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Usual Adult Dose for:

Additional dosage information:

Usual Adult Dose for Cluster Headache

Subcutaneous injection:
Initial dose: 6 mg subcutaneously, once. If symptoms recur, the dose may be repeated if at least 1 hour has elapsed since the first dose.
Maximum dose: 12 mg per 24 hours

Comments:
-Treatment should be started at the first sign of cluster headache, or associated symptoms such as nausea, vomiting, or photophobia. This drug should not be used prophylactically.
-The safety of treating an average of more than 4 headaches in a 30 day period has not been established.

Usual Adult Dose for Migraine

Oral:
Initial dose: 25 mg, 50 mg, or 100 mg orally, once. If symptoms recur, the dose may be repeated if at least 2 hours have elapsed since the first dose.
Maximum dose: 200 mg orally per 24 hours

Nasal spray:
Initial dose: 5 mg, 10 mg, or 20 mg into one nostril, once. If symptoms recur, the dose may be repeated if at least 2 hours have elapse since the first dose.
Maximum dose: 40 mg per 24 hours

Subcutaneous injection:
Initial dose: 1 to 6 mg subcutaneously, once. If symptoms recur, the dose may be repeated if at least 1 hour has elapsed since the first dose.
Maximum dose: 12 mg subcutaneously per 24 hours

Comments:
-Treatment should be started at the first sign of a migraine headache, or associated symptoms such as nausea, vomiting, or photophobia. This drug should not be used prophylactically.
-The nasal spray may be useful in patients who experience nausea and vomiting or who require a rapid onset of effect during an attack.
-Subcutaneous doses of 1 to 5 mg may be used if side effects at 6 mg are dose limiting.
-If the migraine returns after an initial dose of subcutaneous injection, additional doses may be given using the oral tablets, up to 100 mg orally per day, with at least a 2 hour interval between tablet doses.
-The safety of treating an average of more than 4 headaches in a 30 day period has not been established.

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Mild to moderate liver dysfunction:
Oral tablets: Maximum single dose of 50 mg should not be exceeded
Nasal spray: Data not available
Subcutaneous injection: No adjustment recommended

Severe liver dysfunction: Contraindicated

Precautions

Safety and efficacy have not been established in patients younger than 18 years.

Use with caution in elderly patients.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice:
-Sumatriptan tablets should be swallowed whole with water.
-A 10 mg intranasal dose may be administered as 5 mg in each nostril.
-Sumatriptan injection should only be injected subcutaneously. Preferred administration sites are the subcutaneous tissues of the lateral aspect of the thighs or the subcutaneous tissues overlying the deltoid muscles. An autoinjection system is available for self administration.
-Subcutaneous doses other than 4 mg or 6 mg should be administered using the 6 mg single-dose vial.
-The first dose of sumatriptan should be administered by, or under the direct supervision of, a physician in a medically supervised setting in patients with multiple cardiovascular risk factors who have a negative cardiovascular examination.

Storage requirements: The manufacturer's product information should be consulted.

General:
-This drug is only indicated for acute intermittent relief of migraine and cluster headache (subcutaneous injection)
-Treatment should be started at the first sign of a migraine or cluster headache; however, it may be given at any stage of the headache.
-All patients who receive the autoinjection system should be counseled on its use and on the local and systemic effects of sumatriptan.
-If, for a given attack, the patient does not respond to the initial dose of sumatriptan, the diagnosis of migraine or cluster headache should be reviewed prior to the administration of a second dose.
-Doses of 50 and 100 mg oral tablets may provide a greater effect than 25 mg. There is also evidence that 100 mg tablets do not provide a greater effect than 50 mg.
-A greater proportion of patients have been reported to have headache response following a 20 mg dose of nasal spray than following a 5 or 10 mg dose. There is evidence that doses above 20 mg do not provide a greater effect than 20 mg.

General monitoring:
-Cardiovascular: Signs or symptoms consistent with ischemic heart disease
-Gastrointestinal: Abdominal pain and bloody diarrhea
-Local: Injection site reactions (subcutaneous injection)
-Nervous system: Atypical headache; medication overuse headache; signs or symptoms of cerebrovascular events such as stroke
-Other: Serotonin syndrome (when used in combination with an SSRI or SNRI)

Patient advice:
-Take this medicine as soon as possible after the onset of a migraine or cluster headache or associated symptoms such as nausea, vomiting, or photophobia.
-If you do not get relief from the first dose of this medicine, do not take a second dose without first talking to your healthcare provider.
-Use of this medicine for 10 or more days per month may exacerbate headaches; use a headache diary to record how often you have a headache and when you take this medicine.
-Follow the instruction leaflet for the correct administration of the nasal spray, subcutaneous injection or autoinjector device and the safe disposal of syringes and needles after use.
-Drowsiness may occur during a migraine or during its treatment with sumatriptan. Do not drive or operate machinery until you know how this drug affects you.

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