ClinCalc Pro
Menu
Calculators Drugs Pathways AI Dx Donate Get the App
Triptan (5-HT1 agonist) / Antimigraine Pregnancy: Use only if benefit outweighs risk. Limited human data.

Sumatriptan

Brand names: Imigran, Migraitan

Adult dose

Dose: 50–100 mg oral; 6 mg SC; 10–20 mg intranasal
Route: Oral, subcutaneous, or intranasal
Frequency: Single dose; may repeat once after 2 hours if initial response then recurrence
Max: Oral: 300 mg/24h; SC: 12 mg/24h; Intranasal: 40 mg/24h
Take at onset of headache (not aura). Oral: 50 mg (increase to 100 mg if inadequate). SC: 6 mg (fastest onset — most effective for severe migraine). Intranasal: 10–20 mg into one nostril.

Paediatric dose

Route: Intranasal (licensed ≥12 years only)
Frequency: Single dose; may repeat once after 2 hours
Max: Intranasal: 20 mg/24h
12–17 years: intranasal 10 mg (one 10 mg spray into one nostril). Oral sumatriptan not licensed under 18 years but used off-label in specialist practice.

Dose adjustments

Renal

No dose adjustment required.

Hepatic

Oral bioavailability increased in hepatic impairment — use lower doses; max 50 mg oral.

Clinical pearls

  • Most effective when taken at headache onset, not during aura
  • SC route fastest (peak 12 min) — preferred for vomiting or very severe attacks
  • Medication overuse headache if used >10 days/month — address with patient education
  • If chest tightness occurs on first dose — perform ECG and cardiac review before further use
  • Review diagnosis if no response to two triptans

Contraindications

  • Ischaemic heart disease, previous MI
  • Coronary vasospasm (Prinzmetal angina)
  • Peripheral vascular disease
  • Cerebrovascular disease (previous stroke/TIA)
  • Uncontrolled hypertension
  • MAO-A inhibitors (or within 2 weeks)
  • Other triptans or ergotamine within 24 hours

Side effects

  • Chest tightness/pressure (usually benign — muscular; stop if cardiac symptoms)
  • Flushing
  • Tingling and paraesthesia
  • Drowsiness
  • Injection site reactions (SC)
  • Nausea
  • Rebound headache with overuse

Interactions

  • MAO-A inhibitors — contraindicated; risk of serotonin syndrome
  • SSRIs/SNRIs — increased serotonin syndrome risk
  • Ergotamine — contraindicated within 24 hours (additive vasospasm)
  • Other triptans — do not combine within 24 hours
  • Lithium — increased serotonin syndrome risk

Monitoring

  • Blood pressure
  • Frequency of headaches (assess for medication overuse)
  • Cardiac symptoms

Reference: BNFc; BNF; NICE NG150 Headaches; SIGN 155 Migraine. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

Calculators
Pathways