Sumatriptan Paroxetine

Treatment of 12 healthy volunteers with paroxetine (20 mg/day for 14 days) did not alter the pharmacokinetics or pharmacodynamic effects of an acute dose of rizatriptan (10 mg orally) (29). These data are reassuring, but (as with sumatriptan) it is possible that sporadic cases of 5-HT neurotoxicity could still occur when rizatriptan is combined with an SSRI. 

Clinically important, potentially hazardous interactions with amitriptyline, amoxapine, bupropion, citalopram, clomipramine, desipramine, doxepin, fluoxetine, fluvoxamine, imipramine, meperidine, nefazodone, nortriptyline, paroxetine, pizotifen, protriptyline, rizatriptan, sertraline, sibutramine, sumatriptan, trimipramine, tryptophan, venlafaxine, 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... 

A study in 11 healthy subjects found that paroxetine 20 mg daily for 16 days had no effect on the response to a 6-mg dose of subcutaneous sumatriptan, as measured by prolactin levels. The sumatriptan levels remained unaltered, its cardiovascular effects were unchanged and no clinically significant adverse effects occurred. Other studies report that the concurrent use of sumatriptan and SSRIs (fluoxetine 20 to 60 mg daily, fluvoxamine 200 mg daily, paroxetine 20 to 50 mg daily, sertraline 50 to 100 mg daily) was successful and uneventful. No adverse effects have been noted in 148 other patients. However, a case report describes a 65-year-old woman who had been taking paroxetine 20 mg [daily] for a number of years, who developed confusion, strange behaviour, sinus tachycardia, hypertension and hyperthermia shortly after starting sumatriptan. The serotonin syndrome was diagnosed, and she recovered completely on withdrawal of the two drugs. ... 

Additionally, in Canada, post-marketing surveillance of the voluntary reports reeeived by the manufacturers of fluoxetine, identified 2 cases that showed good evidence, and another 4 cases that showed some, but not strong evidence, of reactions consistent with the serotonin syndrome in patients also taking sumatriptan. Other cases describe a decrease in the efficacy of sumatriptan with fluoxetine, dyskinesias and dystonias with sumatriptan and paroxetine, and twenty possible cases of the serotonin syndrome with sumatriptan and SSRIs. ... 

Wii Y-K, Cliffccd EM, Sheehan BD, Camplii GM, Hockney RA, Cowen PJ. Paroxetine treatment and the prolactin response to sumatriptan. Psychopharmacology (Berl) (1996) 124, 377-9. 

Abraham JT, Brown R, Meltzer H Y. Clozapine treatment of persistent paroxysmal dy inesia associated with concomitant paroxetine and sumatriptan use. BiolPsychiatry 991) 42,144-6. 

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