Sumatriptan Methysergide

Do not use dihydroergotamine, 5-HT- agonists (eg, sumatriptan), ergotamine-containing or ergot-type medications, or methysergide within 24 hours of each other. 

ERGOTAMINE, METHYSERGIDE 5-HT1 AGONISTS-TRIPTANS T risk of vasospasm Additive effect 1. Do not administer ergotamine and almotriptan, rizatriptan, sumatriptan or zolmitriptan within 6 hours of each other 2. Do not administer methy-sergide and almotriptan, rizatriptan, sumatriptan or zolmitriptan within 24 hours of each other 3. Do not administer an ergot derivative and eletriptan orfrovatriptan within 24 hours of each other... 

Cluster headaches may be treated with a 5HTj-receptor agonist, e.g. sumatriptan, as for migraine. Since bouts of headache tend to be of limited duration, e.g. a few weeks, short courses of methysergide are justified in intractable cases. 

The combination of methysergide with sumatriptan has been associated with vasospasm in the coronary arteries (6). 

A 43-year-old woman with controlled hypertension, but no other known coronary risk factors, had an acute myocardial infarction. She took two oral doses of methysergide 2 mg 12 hours apart, followed by sumatriptan 6 mg subcutaneously. About 10 minutes after the sumatriptan, she complained of chest pain, and on arrival in hospital, an anterior myocardial infarction was diagnosed. Subsequent angiography showed a solitary stenosis in the left anterior descending coronary artery, and it was therefore presumed that she had suffered vasospasm associated with this stenosis. She made an excellent recovery after stenting. 

Liston H, Bennett L, Usher B Jr, Nappi J. The association of the combination of sumatriptan and methysergide in myocardial infarction in a premenopausal woman. Arch Intern Med 1999 159(5) 511-13. 

A myocardial infarction occurred in a 43-year-old woman with no known coronary artery disease who was taking methysergide and injected herself with sumatriptan 6 mg because of persisting headache (31). 

Clinically important, potentially hazardous interactions with dihydroergotamine, ergotamine, methysergide, oral contraceptives, rizatriptan, sibutramine, St John s wort, sumatriptan, zolmitriptan... 

Clinically important, potentially hazardous interactions with desvenlafaxine, dextromethorphan, dihydroergotamine, ephedra, ergot, fluoxetine, fluvoxamine, isocarboxazid, linezolid, lithium, MAO inhibitors, meperidine, methysergide, naratriptan, nefazodone, paroxetine, phenelzine, rizatriptan, sertraline, sumatriptan, tranylcypromine, tryptophan, venlafaxine, verapamil, zolmitriptan, zuclopenthixol... 

Buspirone, ipsaperone, sumatriptan, and cisapride are agonists whereas methysergide, risperidone, ketanserin, and ondansetron are antagonists at serotonin receptors. 

Myocardial infarction has been reported in a 43-year-old woman after she took two 2-mg doses of methysergide 12 hours apart, followed by sumatriptan 6 mg subcutaneously. Severe chest pain and tightness with breathlessness began 15 minutes later, and results of various tests were consistent with coronary spasm on an area of atherosclerosis . ... 

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