Chest pain with triptans

Side effects of triptans include paresthesias, fatigue, dizziness, flushing, warm sensations, and somnolence. Minor injection site reactions are reported with SC use, and taste perversion and nasal discomfort may occur with intranasal administration. Up to 15% of patients report chest tightness, pressure, heaviness, or pain in the chest, neck, or throat. Although the mechanism of these symptoms is unknown, a cardiac source is unlikely in most patients. Isolated cases of myocardial infarction and coronary vasospasm with ischemia have been reported. 

Coronary vasoconstriction is a potential risk of all triptans, but the risk is minimal in the absence of coronary artery disease or uncontrolled hypertension. Chest tightness and pain are reported in up to 15% of patients taking sumatriptan and are presumed to be due to vasoconstriction of the coronary arteries. Myocardial infarction has been reported and as a consequence sumatriptan should not be used in patients with cardiovascular disease (11). Intravenous sumatriptan causes some coronary vasoconstriction during diagnostic angiography. Myocardial infarction occurred in a patient who had received sumatriptan 6 mg subcutaneously, but the causal association was not clear. 

Vasoconstriction is a well known adverse effect of ergot derivatives, and coronary vasoconstriction may also occur rarely with the triptans. (Note that in 1992, soon after the marketing of sumatriptan, the CSM in the UK had received 34 reports of pain or tightness in the chest caused by sumatriptan, possibly due to coronary vasoconstriction. ) It is therefore theoretically possible that the drugs may have additive vasoconstrictive effects, although there is little evidence of this in practice. 

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