Sumatriptan Dosage

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Usual Adult Dose for:

Usual Pediatric Dose for:

Additional dosage information:

Usual Adult Dose for Cluster Headache

Initial dosage when symptoms of headache appear:

Subcutaneously: 4 to 6 mg; may repeat if needed at least 1 hour after initial dose; maximum: 12 mg/day.

ORAL: Initial single dose: 25 mg given with fluids as soon as possible after the onset of a migraine; range: 25 to 100 mg/dose; maximum single dose: 100 mg; may repeat after 2 hours; maximum: 200 mg/day taken. The maximum single oral dose recommended is 100 mg. Do not split tablets.

NASAL SPRAY: Initial single dose: 5 mg, 10 mg, or 20 mg administered in one nostril, given as soon as possible after the onset of migraine; 10 mg dose may be administered as 5 mg in each nostril; may repeat after 2 hours; maximum: 40 mg/day.

Usual Adult Dose for Migraine

Initial dosage when symptoms of headache appear:

Subcutaneously: 4 to 6 mg; may repeat if needed at least 1 hour after initial dose; maximum: 12 mg/day.

ORAL: Initial single dose: 25 mg given with fluids as soon as possible after the onset of a migraine; range: 25 to 100 mg/dose; maximum single dose: 100 mg; may repeat after 2 hours; maximum: 200 mg/day taken. The maximum single oral dose recommended is 100 mg. Do not split tablets.

NASAL SPRAY: Initial single dose: 5 mg, 10 mg, or 20 mg administered in one nostril, given as soon as possible after the onset of migraine; 10 mg dose may be administered as 5 mg in each nostril; may repeat after 2 hours; maximum: 40 mg/day.

Usual Pediatric Dose for Migraine

Use in children and adolescents less than 18 years of age not recommended by manufacturer. Results of clinical studies are mixed with regards to efficacy, particularly with oral and injectable sumatriptan.

Intranasal:
Children 5 to 12 years: 5 mg, 10 mg, or 20 mg administered in one nostril as a single dose. A double-blind, placebo controlled study of 129 patients (8 to 17 years) used a weight-based dosing regimen: 20 to 39 kg: 10 mg; 40 kg or more: 20 mg. A small retrospective review of 10 children (5 to 12 years; mean: 9.9 years), used intranasal doses of 5 mg (n=2) or 20 mg (n=8).
Adolescents 12 years or older: 5 mg, 10 mg, or 20 mg administered in one nostril as a single dose.

Subcutaneously: Children and Adolescents 6 to 18 years: 3 to 6 mg single dose. An open labeled prospective trial of 17 children 6 to 16 years with juvenile migraine used subcutaneous doses of 6 mg in 15 children (30 to 70 kg), and 3 mg/dose in two children (22 kg and 30 kg). Another open-label prospective trial in 50 consecutive children (ages 6 to 18 years) with severe migraine used subcutaneous doses of 0.06 mg/kg/dose. Relief was reported as good/excellent in 84% of the patients; 16% reported fair to poor relief; additional studies are needed.

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Mild to moderate hepatic impairment:
Oral: Bioavailability of oral sumatriptan is increased with liver disease. If treatment is needed, do not exceed single doses of 50 mg.
Nasal spray: Has not been studied in patients with hepatic impairment; however, because the spray does not undergo first-pass metabolism, concentrations would not be expected to alter.
Subcutaneous: Has been studied and pharmacokinetics were not altered in patients with hepatic impairment compared to healthy patients.
Severe hepatic impairment:
Oral, nasal, and subcutaneous (limited to Imitrex injection, per prescribing information) formulations are contraindicated with severe hepatic impairment.

Dose Adjustments

oral: There is evidence that doses of 50 and 100 mg 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.

nasal: 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.

Precautions

Sumatriptan should not be used in patients with basilar or hemiplegic migraine.

Sumatriptan should not be administered to patients with a history, signs, or symptoms of ischemic cardiac, cerebrovascular, or peripheral vascular syndromes. Because sumatriptan may increase blood pressure, it should not be administered to patients with uncontrolled hypertension.

Sumatriptan should not be given to patients in whom unrecognized coronary artery disease (CAD) is predicted by the presence of risk factors unless a cardiovascular evaluation provides satisfactory clinical evidence that the patient is reasonably free of coronary artery and ischemic myocardial disease or other significant underlying cardiovascular disease.

For patients who may be at increased risk of unrecognized cardiovascular disease, who are determined to have a satisfactory cardiovascular evaluation, the first dose of sumatriptan should be given under direct medical supervision. Because cardiac ischemia may occur in the absence of clinical symptoms, use of an electrocardiogram (ECG) during the interval immediately following sumatriptan injection may be appropriate for patients with risk factors.

Chest discomfort, jaw, or neck tightness have been reported after the sumatriptan injection. These symptoms also have been reported less frequently with the tables and the nasal spray. However, because sumatriptan may cause coronary artery vasospasm, patients who experience the mentioned adverse effects should be evaluated for angina or coronary artery disease before receiving any more doses of sumatriptan.

Dialysis

Data not available

Other Comments

Clinical trials of the injectable form of sumatriptan have failed to show that any clear benefit is associated with the administration of a second 6 mg dose in patients who failed to respond to the first injection. However, some patients who respond to the first dose may be given a second dose if symptoms of headache recur.

Subcutaneous doses should be separated by at least 1 hour. Oral or nasal doses should be separated by at least 2 hours.

The manufacturer reports that the maximum recommended dose in any 24 hour period is 12 mg subcutaneously, 200 mg orally, or 40 mg intranasally.

The preferred sites of sumatriptan injection are into the subcutaneous tissues of the lateral aspect of the thighs or the subcutaneous tissues overlying the deltoid muscles. For patients who respond to the 6 mg dose and tolerate it well, an autoinjection system is available for self-administration. All patients who receive the autoinjection system should be counseled on its use and on the local and systemic effects of sumatriptan.

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