Coronary artery disease triptans

Seven triptans have been compared and rated as generally very well tolerated (10). Naratriptan, almotriptan, and frovatriptan were considered to have the best safety profiles, although the differences are minor. Coronary vasoconstriction is a potential risk of the entire class, but the risk is minimal in the absence of coronary artery disease or uncontrolled hypertension significant vascular disease is therefore a hazard of using any of the triptans. Patient preference, however, appears to be more closely related to efficacy than to tolerance. 

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. 

Ergot alkaloids are contraindicated in women who are or may become pregnant, because the drugs may cause fetal distress and miscarriage. Ergot alkaloids also are contraindicated in patients with peripheral vascular disease, coronary artery disease, hypertension, impaired hepatic or renal fnnction, and sepsis. Ergot alkaloids should not be taken within 24 honrs of the use of the triptans, and should not be nsed concnrrently with other drugs that can cause vasoconstriction. 

The triptans are contraindicated in patients who have a history of ischemic or vasospastic coronary artery disease. 

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