Triptan Master Table

Use as a resource with your neurologist ONLY. 

Class Route Onset of Action Initial Dose Max Daily Dose Dosing Intervals Notes Significant Drug Interactions
Sumatriptan Oral [tablet] 30 minutes 25 mg, 50 mg, 100 mg 200 mg

2 hours


(max see left)

  • May cause tingling or warm sensation and flushing. Heavy feeling in legs is also a common adverse effect (possible in other routes too)
  • Cheaper than other forms of sumatriptan.
  • Do not use within 14 days of using an MAOI.
Subcutaneous 10-15 minutes 3 mg, 4 mg, 6 mg 12 mg

1 hour


(max see left)

  • Available in a single dose vial, prefilled syringe, or a prefilled autoinjector
  • Very fast onset of action.
  • More efficacious than oral route.
  • Do not use within 14 days of using an MAOI.

Intranasal:


Imitrex [spray]


Tosymra [spray]


Onzetra Xsail [powder]

15 minutes

Imitrex: 5 mg, 20 mg per actuation (use once in 1 nostril)


Tosymra: 10 mg per actuation (use once in 1 nostril)


Onzetra Xsail: 11 mg/capsule in disposable nosepiece (use in both nostrils. 22 mg total)

Imitrex: 40 mg


Tosymra: 30 mg


Onzetra Xsail: 44 mg

Imitrex and Onzetra Xsail: 2 hours


Tosymra: 1 hour


(max see left)

  • Fast onset of action
  • Nasal spray beneficial if migraine attacks are accompanied with nausea/vomiting.
  • DDM additive in Onzetra Xsail increases rate of absorption.
  • Do not use within 14 days of using an MAOI.
Rizatriptan

Oral:


Maxalt [tablet]


Maxalt MLT [ODT]


RizaFilm [film]

30-60 minutes

Tablet & ODT: 5mg or 10mg


Film: 10 mg

30 mg

2 hours


(max see left)

  • Higher rate of headache recurrence.
  • Patients taking propranolol: Limit dose to 5 mg PO and do not exceed 15 mg/24 hr.
  • RizaFilm contraindicated in patients taking propranolol.
  • Patients taking propranolol: Limit dose to 5 mg PO and do not exceed 15 mg/24 hr.
  • Do not use within 14 days of using an MAOI.
Zolmitriptan Oral [tablet and ODT] 45 minutes 2.5 mg, 5 mg 10mg

2 hours


(max see left)

  • Only the tablet has a score line to achieve a lower dose.
  • Do not break the ODT.
  • 1.25 mg dose is commonly used after breaking tablet.
  • Limit zolmitriptan to 2.5 mg/dose and 5 mg/day if given with cimetidine.
  • Do not use within 14 days of using an MAOI.
Intranasal 10-15 minutes 2.5 mg, 5 mg per spray (1 spray in 1 nostril) 10 mg

2 hours


(max see left)

  • Decreased amount of taste disturbance when compared to sumatriptan.
  • Limit zolmitriptan to 2.5 mg/dose and 5 mg/day if given with cimetidine.
  • Do not use within 14 days of using an MAOI.
Almotriptan

Oral


Axert [tablet]

30-120 minutes 6.25 mg, 12.5 mg 25 mg

2 hours


(max see left)

  • Less risk of adverse effects like paraesthesia, fatigue, and back pain compared to other triptans.
  • Dose adjustment necessary if taken with CYP3A4 inhibitors.
  • Common dose adjustment is a starting dose of 6.25 mg and the maximum daily dose should not exceed 12.5 mg in 24 hrs.
Eletriptan

Oral


Relpax [tablet]

30-60 minutes 20 mg, 40 mg

United States: 80 mg


Canada: 40 mg

2 hours


(max see left, repeat of 40 mg dose is not recommended)

  • Superior efficacy to sumatriptan.
  • Higher risk of adverse effects.
  • Do not use within 72 hours of using CYP3A4 inhibitors such as ketoconazaole and itraconazole.
Frovatriptan

Oral


Frova [tablet]

Slow onset, 2-4 hrs 2.5mg

United States: 7.5 mg


Canada: 5 mg

United States: 2 hours


Canada: 4 hours


(max see left)

  • Used off-label for mini-prevention of menstrual migraine. (Class A evidence by the American Headache Scoiety)
  • Less effective
  • Less adverse effects
  • Slow onset
  • Long duration
None
Naratriptan

Oral


Amerge [tablet]

1-3 hrs 1mg, 2.5mg 5mg

4 hours


(max see left)

  • Lowest risk of adverse effects
  • Less effective
  • Due to long duration of activity, may be used off-label for morning headaches.
None
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