Migraine Medication List

Triptans

almotriptan (Axert ®)

Drug Category: Antimigraine Agent. Serotonin 5-HT1B, 1D Receptor Agonist.

Indications: acute treatment of migraine with or without aura in adults.

Dosing (Adults) (usual): Migraine:Oral: Initial: 6.25-12.5 mg in a single dose; if the headache returns, repeat the dose after 2 hours; no more than 2 doses in 24-hour period. Maximum dose: 25 mg/day. Note: If the first dose is ineffective, diagnosis needs to be re-evaluated. Safety of treating more than 4 migraines/month has not been established.

Renal Dosing / hepatic impairment: Initial: 6.25 mg in a single dose; maximum daily dose: 12.5 mg.

[Supplied: 6.25 mg, 12.5 mg tab.]

eletriptan (Relpax ®)

Serotonin-1D (5-HT1D) receptor agonist.
Dosing (Adults) (initial): 20 to 40 mg. May repeat after 2 hours if headache returns. Maximum single dose 40 mg. Maximum of 80 mg per 24 hours. Oral eletriptan is effective in the treatment of acute migraine attacks, and may be faster-acting than oral sumatriptan. It will compete with oral rizatriptan and oral zolmitriptan (which also have a relatively rapid onset) as a substitute for oral sumatriptan in moderate-to-severe migraine headache.

frovatriptan (Frova ®)

Serotonin receptor agonist, 5-ht1.
Adult (usual): Migraine headache: 2.5 mg orally. May repeat after 2 hr. Maximum 7.5 mg/24 hr.
[Supplied: 2.5 mg tablet ]

naratriptan (Amerge ®)

Dosing (Adults): Initially take 1 to 2.5 mg orally. May repeat in 4 hours for maximum daily dose of 5 mg.

rizatriptan (Maxalt ®)

Dosing (Adults): Initially 5-10 mg orally, may repeat in 2 hours. Maximum dose of 30 mg/ day.

sumatriptan (Imitrex ®)

Dosing (Adults): Initially 6 mg subcutaneously, may repeat in 1 hour. Maximum of 12 mg/day.
Oral dosing: 25 mg orally x 1, if no response, may give 25-100mg every 2 hours to a maximum of 200-300mg/ day.

zolmitriptan (Zomig ®)

MOA: Selective agonist for serotonin (5-HT1B and 5-HT1D receptors) in cranial arteries to cause vasoconstriction and reduce sterile inflammation associated with antidromic neuronal transmission correlating with relief of migraine

Migraine headache: Tablet: Initially 1.25mg (half-tab) to 2.5 mg orally x 1 at the onset of migraine headache. Orally-disintegrating tablet: Initial: 2.5 mg at the onset of migraine headache. Nasal spray: Initial: 1 spray (5 mg) at the onset of migraine headache.
If the headache returns, the dose may be repeated after 2 hours. Do not exceed 10 mg within a 24-hour period. Note: Use the lowest possible dose to minimize adverse events.
Controlled trials have not established the effectiveness of a second dose if the initial one was ineffective

Supplied: Nasal spray [single dose] (Zomig®): 5 mg/0.1 mL (0.1 mL).
Tablet (Zomig®): 2.5 mg, 5 mg.
Tablet (orally-disintegrating) (Zomig-ZMT™): 2.5 mg, 5 mg.

Other

Cafergot ® (ergotamine/caffeine)

Dosing (Adults): Initially 2 tablets orally at onset. If no relief take 1 tablet every 30 minutes-- up to a maximum of 6 tablets per attack. ** Maximum of 10 tablets per weekd

dihydroergotamine (DHE 45 ®)

Dosing (Adults): Initially I mg IV/IM/SC, repeat in 1 hr as needed. Maximum 2 mg (IV) or 3 mg (IM/SC) per day.

Midrin ® (isometheptine/ dichlorphenazone/ apap):

Dosing (Adults): Initially 2 tabs orally x 1 then 1 tablet every hour until relief. Maximum of 5 tablets in a 12 hour period.

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David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc.

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