Migraine Acute Tx - Drug Table
|
Migraine – Acute Therapy – Drug Table |
|||||
|---|---|---|---|---|---|
|
Category |
Drug Name |
Common Dosing |
Maximum Daily Dose |
Cost* |
Patient Education (Comments & Warnings) |
|
Non-NSAIDs |
Acetaminophen (extra strength) |
1,000mg 3-4x/day |
3,000-4,000mg/day |
$3.21 |
· Be aware that many OTC products contain APAP which count toward daily total · Caution in patients with renal impairment and at risk for GI bleed |
|
Ginger powder |
250mg |
NA |
NA |
· Purchase products with USP on bottle if able · Variability in dosing |
|
|
NSAIDs |
Excedrin Migraine APAP/ASA/Caffeine |
250mg/250mg/65mg |
2 tabs 8 tablets/24 hours |
$7.38 |
· Inform patient it contains ASA · Administer with food |
|
Ibuprofen |
200-400mg |
2,400mg/day |
$11.47 |
· Administer with food or milk · Caution in patients with renal impairment and at risk for GI bleed |
|
|
Aspirin |
1,000mg |
4,000mg/day |
$12.84 |
· Administer with food or full glass of water · Caution in patients with renal impairment and at risk for GI bleed |
|
|
Diclofenac Potassium |
50mg |
200mg for 1st 24 hours, 150mg thereafter |
$55.81 |
· Administer with food or milk · Do not crush ER formulation · Caution in patients with renal impairment and at risk for GI bleed |
|
|
Ketorolac (Toradol) |
≥50kg IM: 60mg single dose or 30mg every 6 hours
≤50kg or ≥65 years of age IM: 30mg single dose or 15mg every 6 hours |
120mg/day
60mg/day |
$40.11 |
· Max combined duration of treatment is 5 days · Take oral formulation with food to avoid GI upset · Caution in patients with renal impairment, CAD, and those at risk for GI bleed |
|
|
Triptans |
Sumatriptan (Imitrex) |
Oral 25-100mg dose; may repeat in 2 hours Intranasal 5-20mg; may repeat in 2 hours SubQ 6mg; may repeat in 1 hour |
Oral 200mg/day
Intranasal 40mg/day
SubQ 6mg/dose 12mg/day |
$155.05 |
|
|
Rizatriptan (Maxalt) |
10mg; may repeat after 2 hours If using propranolol then 5mg/dose |
30mg/day 15mg/day |
$178.32 |
· Can give with or without food · ODT should be placed on tongue and allowed to dissolve |
|
|
Eletriptan (Relpax) |
20-40mg May repeat after 2 hours |
40mg/dose & 80mg/day |
$286.22 |
· May take with food |
|
|
Zolmitriptan (Zomig) |
Nasal 2.5mg
Oral 1.25-2.5mg
ODT 2.5mg |
10mg/day Nasal 5mg/dose
Oral 5mg/dose
ODT 5mg/dose |
$290.10 |
· Proper administration with nasal formulation · Can break in half to achieve smaller dose · ODT must be taken whole; place on tongue and allow to dissolve |
|
|
IV Therapies |
Prochlorperazine (Compazine) |
IM/IV 10mg
Rectal 25mg |
IM/IV 10mg
Rectal 25mg |
$26.62 |
· May be given with 25mg IV Benadryl piggyback · Avoid use in elderly · Monitor for extrapyramidal symptoms |
|
Chlorpromazine (Thorazine) |
12.5mg slow IV infusion |
25mg |
$143.13 |
· Avoid use in elderly · Monitor for extrapyramidal symptoms |
|
|
Metoclopramide (Reglan) |
10mg IV push or slow IV infusion |
|
$10.18 |
· Monitor for extrapyramidal symptoms |
|
|
Dihidroergotamine |
Nasal 1 spray in each nostril; repeat q15min
IV 0.5-1mg q8h, or continuous infusion 3mg/24h
SQ 1mg q1h |
Nasal 4 sprays
IV 3mg
SQ 3mg |
Nasal $3,210.46
Vial $1,600.40 |
· Typically used under direction of neurologist |
|
|
Dexamethasone |
10-25mg x1 |
NA |
$19.95 |
· Used as adjunct to prevent short-term migraine recurrence · Do not give with 3A4 inhibitors and macrolides |
|
*Cost estimates are the average cost reported on GoodRx.com as of April 2021