Triptans (serotonin 1b/1d agonists) for acute treatment of adults with migraine

Triptan	Route (preparations)	Typical initial dose	Maximum dose per 24 hours	Notes
Sumatriptan	Oral (tablet)	50 to 100 mg	200 mg
	SUBQ (solution for injection)	6 mg	12 mg	More efficacious than oral route with greater adverse effects May repeat dose after 1 hour If 6 mg dose is not tolerated, may use reduced dose (eg, 3 or 4 mg) Autoinjectors (3 mg, 4 mg, or 6 mg) are also available
	Intranasal (spray and powder)			DDM additive increases rate of absorption; nasal spray coformulated with DDM is used at a lower dose (ie, 10 mg), which may be repeated after 1 hour
	Spray (Imitrex and generics)	20 mg in one nostril	40 mg
	Spray (coformulated with DDM; Tosymra)	10 mg in one nostril	30 mg
	Powder	22 mg (11 mg capsule insufflated in each nostril)	44 mg
Zolmitriptan	Oral (tablet and ODT)	2.5 to 5 mg	10 mg	Oral tablet (but not ODT) may be split to achieve smaller dose
Zolmitriptan	Intranasal (solution)	2.5 or 5 mg in one nostril	10 mg	Less taste disturbance than intranasal sumatriptan
Eletriptan	Oral (tablet)	20 to 40 mg	80 mg	In general, 40 mg dose is recommended due to greater efficacy, however 20 mg may be better tolerated Metabolized by CYP3A4; do not use within 72 hours of a CYP3A4 inhibitor*
Rizatriptan	Oral (tablet, ODT, film)	Tablet, ODT: 5 to 10 mg Film: 10 mg	30 mg	Use reduced dose in patients taking propranolol* Do not split 10 mg film to achieve a smaller dose
Almotriptan	Oral (tablet)	12.5 mg	25 mg	May be better tolerated than many other triptans Metabolized by CYP3A4; dose adjustment or avoidance may be required with CYP3A4 inhibitors*
Naratriptan	Oral (tablet)	2.5 mg	5 mg	Slower onset and longer duration of effect than many other triptans May have lower efficacy but be better tolerated than many other triptans May repeat dose after 4 hours
Frovatriptan	Oral (tablet)	2.5 mg	5 mg	Slower onset and longer duration of effect than many other triptans May have lower efficacy but be better tolerated than many other triptans

Several triptans are effective options for acute treatment of migraine. Choice of triptan should be individualized; patients who do not respond well to one triptan may respond to another. For patients using a triptan, treatment should be started early after onset of migraine symptoms. Dose may be repeated after two hours if response to initial dose is suboptimal, unless otherwise noted, up to the maximum dose in a 24-hour period. Triptans should not be administered within 24-hour use of another triptan or ergotamine agents. Limit use to less than 10 days per month to avoid medication-overuse headache. Triptans should be avoided for patients with hemiplegic migraine or migraine with brainstem aura and those with a history of ischemic stroke, ischemic heart disease, uncontrolled hypertension, and pregnancy. Refer to UpToDate for additional details.

SUBQ: subcutaneous; DDM: n-Dodecyl beta-D-maltoside; ODT: orally disintegrating tablet; CYP3A4: cytochrome P450 isoenzyme 3A4.

* Refer to Lexicomp drug interactions database for specific recommendations.

Graphic 141582 Version 4.0

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Triptans (serotonin 1b/1d agonists) for acute treatment of adults with migraine