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Sumatriptan contraindications and the serotonin syndrome
1Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada.
The Annals of Pharmacotherapy
|February 26, 1998
Summary
The risk of serotonin syndrome when using sumatriptan with monoamine oxidase inhibitors (MAOIs), serotonin selective-reuptake inhibitors (SSRIs), or lithium is low. Most patients tolerate sumatriptan with SSRIs or lithium, but caution is advised with MAOIs.
Area of Science:
- Pharmacology
- Clinical Toxicology
- Drug Safety
Background:
- Sumatriptan is a common medication for migraines.
- Monoamine oxidase inhibitors (MAOIs), serotonin selective-reuptake inhibitors (SSRIs), and lithium are often used concurrently with sumatriptan.
- Concerns exist regarding the potential for serotonin syndrome with these combinations.
Purpose of the Study:
- To evaluate the risk of serotonin syndrome from combining sumatriptan with MAOIs, SSRIs, or lithium.
- To assess the clinical evidence supporting current contraindications for these drug combinations.
Main Methods:
- A comprehensive literature search was performed using multiple databases.
- Reports of serotonin syndrome associated with sumatriptan use were collected.
- Data from drug manufacturers and global monitoring centers were also solicited.
Main Results:
- 16 cases of suspected serotonin syndrome were reported with sumatriptan and SSRIs; 2 cases with sumatriptan and lithium.
- No reports of serotonin syndrome were found involving sumatriptan and MAOIs.
- Numerous reports documented sumatriptan use without adverse events alongside SSRIs, MAOIs, and lithium.
Conclusions:
- Evidence does not support strict contraindications for MAOIs, SSRIs, and lithium with sumatriptan.
- Most patients tolerate sumatriptan with SSRIs or lithium without issues.
- Sumatriptan should be avoided with MAOIs due to limited safety data.