Sumatriptan MAOIs

Drugs that may affect venlafaxine include cimetidine, cyproheptadine, and MAOIs. Drugs that may be affected by venlafaxine include clozapine, desipramine, haloperidol, indinavir, St. John s wort, trazodone, sibutramine, sumatriptan, and warfarin. 

Uses Obesity Action Blocks uptake of norepinephrine, serotonin, dopamine Dose 10 mg/d PO, may to 5 mg after 4 wk Caution [C, -] w/ SSRIs, Li, dextromethorphan, opioids Contra MAOI w/in 14 d, uncontrolled HTN, arrhythmias Disp Caps SE HA, insomnia, xerostomia, constipation, rhinitis, tach, HTN Interactions T Risk of serotonin synd W/ dextromethorphan, ergots, fentanyl, Li, meperidine, MAOIs, naratriptan, pentazocine, rizatriptan, sumatriptan, SSRIs, tryptophan, zolmitriptan, St. John s wort effects W/ cimetidine, erythromycin, ketoconazole T CNS depression W/ EtOH EMS Use fentanyl w/ caution, may T risk of serotonin synd concurrent EtOH use can T CNS depression OD May cause tach, HTN, diaphoresis, HA, fever, agitation, muscle tremors, and Szs symptomatic and supportive... 

Gardner DM, Lynd LD Sumatriptan contraindications and the serotonin syndrome. Ann Pharmacother 32 33-38, 1998 Gardner DM, Shulman KI, Walker SE, et al The making of a user friendly MAOI diet. J Clin Psychiatry 57 99-104, 1996 Glassman AH, Bigger JT Cardiovascular effects of therapeutic doses of tricyclic antidepressants a review. Arch Gen Psychiatry 38 815-820,1981... 

Serotonin syndrome SSRIs, second generation antidepressants, MAOIs, linezolid, tramadol, meperidine, fentanyl, ondansetron, sumatriptan, MDMA, LSD, St. John s wort, ginseng Hypertension, hyperreflexia, tremor, clonus, hyperthermia, hyperactive bowel sounds, diarrhea, mydriasis, agitation, coma onset within hours Sedation (benzodiazepines), paralysis, intubation and ventilation consider 5-HT2 block with cyproheptadine or chlorpromazine... 

The serotonin syndrome is a rare but dangerous complication of SSRIs and features restlessness, tremor, shivering and myoclonus possibly leading on to convulsions, coma and death. Risk is increased by co-administration with drugs that enhance serotonin transmission, especially MAOIs, the antimigraine drug sumatriptan and St. John s Wort. 

Because sibutramine inhibits serotonin uptake, and because the serious serotonin syndrome has been seen when serotonergic drugs were taken with SSRIs, the manufacturers say that sibutramine should not be taken with any serotonergic drugs. They name dextromethorphan, dihydroergot-amine, fentanyl, pentazocine, pethidine (meperidine), SSRIs, sumatriptan, and tryptophan. Possible cases have been reported for sibutramine and SSMs , (below).The US manufacturers also include lithium in their list. Note that this list is not exhaustive (see MAOIs under (d) above) and a case of the serotonin syndrome has been seen when venla-faxine was given with sibutramine. ... 

Moclobemide markedly inhibits the metabolism of rizatriptan, and approximately doubles the bioavailability of sumatriptan. The manufacturers contraindicate these triptans with moclobemide and non-selective MAOIs. Moclobemide modestly inhibited the metabolism of zolmitriptan but had no clinically significant effect on almotriptan or frovatriptan. 

Selegiline does not interact with sumatriptan or zolmitriptan, and would not be expected to interact with any of the other triptans. Non-selective MAOIs (e.g. phenelzine) are not expected to inter-... 

A comprehensive search of the literature and reports from proprietary manufacturers, identified published reports of 31 patients taking sumatriptan and MAOIs concurrently, but no adverse events were reported, and a patient taking moclobemide 300 mg three times daily had no adverse effects when given oral sumatriptan 100 mg on six occasions."... 

The interaetion between moelobemide and sumatriptan appears to be established. The same interaetion seems likely to oeeur with any RIMA or non-seleetive MAOI, but not with the seleetive MAO-B inhibitors like selegiline. However, the inereased sumatriptan bioavailability appears not to be elinieally important beeause, in the study eited, those subjeets taking moelobemide did not experienee any more adverse effeets than those taking the selegiline or plaeebo. Despite this the UK manufaeturers of sumatriptan quite elearly say that the eoneurrent use of sumatriptan and MAOIs is eontraindieated both during and for 2 weeks after stopping an MAOI. ... 

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