Triptans fluoxetine

Caution has been advocated when SSRIs such as fluoxetine are combined with the triptans that are used to treat acute episodes of migraine (SEDA-24,16). There are case reports of symptoms suggestive of serotonin toxicity when fluoxetine has been combined with sumatriptan, perhaps because the SSRI can potentiate the 5-HT1B/iD agonist effects of the triptan (SEDA-22,14). 

Fleishaker JC, Ryan KK, Carel BJ, Azie NE. Evaluation of the potential pharmacokinetic interaction between almo-triptan and fluoxetine in healthy volunteers. J Clin Pharmacol 2001 41(2) 217-23. 

A two-period crossover, double-blind study in 20 subjects given fluoxetine 20 mg or a placebo daily for 28 days, with zolmitriptan 10 mg on day 28, found that the pharmacokinetics of zolmitriptan were unaffected by fluoxetine. Only very slight changes were seen in the pharmacokinetics of its active metabolite. Sertraline, paroxetine, and citalopram are also not expected to alter the pharmacokinetics of zolmitriptan. However, fluvoxamine, a CYP1A2 inhibitor, is predicted to increase levels of zolmitriptan, based on the known interaction with cimetidine (see Triptans Zolmitriptan + Cimetidine , p.608). 

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