| 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 |
