Drug interactions with triptans : which are clinically significant?

The triptans are a group of compounds with high efficacy for the acute treatment of migraine and cluster headache. They have a relatively wide therapeutic index, and although a number of minor pharmacokinetic interactions have been observed, few are likely to be clinically significant. Given the differences in principal elimination pathways, potentially interacting drugs on a pharmacokinetic basis are not common across all compounds. Of more concern than pharmacokinetic interactions are pharmacodynamic interactions. Of most concern, additive vasoconstrictor effects are likely to occur with other vasoconstrictors, especially the ergots used for migraine. Serotonin syndrome has been observed due to coadministration of triptans with selective serotonin reuptake inhibitors (SSRIs), but the absolute rate of such a clinical response to coadministration is probably low. Most patients can take triptans with other medications without dose alteration, although vigilance is required for pharmacodynamic interactions.