max dose of Triptans

[medical6969]

Confusion upon confusion,

when you have to write on the label 'no more than XXX doses in 24 hours'
what do you write for sumatriptan?

With all the other triptans if you take a 2nd dose (after 2 hours) you have automatically reached the maximum dose, so you simply write TWO on the label.

However, with sumatriptan if they are taking a 50mg tablet and then take a 2nd dose of 50mg, they are still way off the maximum daily dose of 300mg. So theoretically they could take another 50 mg tablet after another 2 hours, and keep doing it until they have taken 300mg ! So do you write 'SIX tablets in 24 hours' ???

Hope it makes sense.

[shan]

Well maximum dose for any drug is a guideline to prevent overdosage. It does not mean that if the maximum dose is stated then the patient has to keep taking the drug till the maximum dose is reached. The maxumum dose lets the physician decide titration of dose to a maximum allowable dose till which point you can expect a good level of effect without toxic effects. In cases like the triptans, where the drug has not benefitted within the recommended dose that means the patient either needs an alternative or complete change over of therapy.

Shan

[Shwampa]

For sumatriptan:

Take ONE tablet at onset of migraine; If no relief, do not repeat dose for same attack. if symptoms recur following response, you may take another dose; maximum: 300 mg/24 hours.

[medical6969]

I'm still not happy with what to put on the label.
Let me make the query clear so you can help.

Script for "sumatriptan 50mg tabs send 6. Take one as directed".

Now the label I stick on the box will have the above dosage AND a sentence saying 'maximum of ___ in 24 hours'.
I know the maximum dose of sumatriptan is 300mg BUT if I write in '6' (i.e. 6 x 50mg = 300mg) in the space above, it could result in the patient taking one 50mg tablet at the onset of the attack, then 2 hours later taking FIVE 50mg tablets.

Is such a lopsided dosage o.k?

[crit care]

i wouldn't have interpreted your directions as the need to take all 5 tablets 2hours later after te first dose....is this an actual case or theoretical??...you could always ask the patient if they know how to take their medication....and like has been mentioned above, the max. dose does not mean the patient has to take that many tablets, they could be controlled on just the one!

[hibernia]

, the max. dose does not mean the patient has to take that many tablets, they could be controlled on just the one!

Many people regard the max dose as a target, not a limit, much like we view speed limits, and not only aim for it but then take a another couple just to be sure it will work.
This is especially the case with analgeics where a person in pain will ignore warnings. One patient who took 14 paracetamol over a 16 hour period, despite clear warning that max was 8 in 24 hours, told me "they always leave a a bit of room for error in these things"

[Pharmanaut]

I think Cedgedim Pharmacy Manager comes up with 50mg : 6 per day and 100mg 3 per day. Working from memory at weekend.