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.

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]

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.

Oral:

Maxalt [tablet]

Maxalt MLT [ODT]

RizaFilm [film]

Tablet & ODT: 5mg or 10mg

Film: 10 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.

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.

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.

Oral

Axert [tablet]

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.

Oral

Relpax [tablet]

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.

Oral

Frova [tablet]

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

Oral

Amerge [tablet]

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.