Sumatriptan contraindications

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... 

Gardner DM, Lynd LD. Sumatriptan contraindications and the serotonin syndrome. Ann Pharmacother 1998 32(l) 33-8. 

NSAIDs are contraindicated after 37 weeks gestation. For refractory migraines, narcotics may be used. Salicylates and indomethacin should be avoided throughout pregnancy if possible. The use of sumatriptan is controversial. Nausea of migraines may be treated with metoclopramide. 

Sumatriptan, a 5HT agonist, is contraindicated in ischaemic heart disease as it may cause vasoconstriction, leading to chest tightness, and precipitating ischaemic heart disease. 

MAO inhibitors Because of the potential of MAO-A inhibitors to cause unpredictable elevations in the bioavailability of oral sumatriptan, their combined use is contraindicated. 

The adverse effects of the different members of the triptan class are quite similar, with the exception of chest oppression which is frequent with sumatriptan. Nausea, vomiting, fatigue, vertigo are frequently reported. Triptans are contraindicated (perhaps excessively) in aura migraine. 

The 1996 Canadian Product Monograph for sumatriptan (but not the 1998 US package insert) listed the combination of sumatriptan and lithium as contraindicated. However, in a review, there was little evidence of a severe interaction of sumatriptan with lithium (692). 

CAD, CHF, uncontrolled HTN ergot or 5HT agonist use within 24 hr hemi-plegic/basilar migraine. Specific contraindications Wofff-Parkinson-White syndrome (zolmitriptan) PVD (frovatriptan) MAO-A inhibitor use within 2 weeks (sumatriptan, rizatriptan, zolmitriptan, frovatriptan). 

The triptans are contraindicated in patients who have a history of ischemic or vasospastic CAD, cerebrovascular or peripheral vascular disease, or other significant cardiovascular diseases. Because triptans may cause an acute, usually small, increase in blood pressure (BP), they also are contraindicated in patients with uncontrolled hypertension. Naratriptan is contraindicated in patients with severe renal or hepatic impairment. Rizatriptan should be used with caution in patients with renal or hepatic disease but is not contraindicated in such patients. Sumatriptan, rizatriptan, and zolmitriptan are contraindicated in patients who are taking monoamine oxidase inhibitors. 

Simultaneous use of the ei ot derivatives is contraindicated with all the triptans because of the theoretical risk of additive vasoconstriction, although this has been demonstrated only in one study with sumatriptan, and there is one isolated case of myocardial in-... 

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. 

Concomitant treatment with irreversible MAO inhibitors, phenelzine, (/)-deprenyl, digitalis glycosides, or 5-HTlD agonists (e.g. sumatriptan) is an absolute contraindication. 

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