Sumatriptan Fluoxetine

Varian (see Catalog, SPE products) Focus Polar functionalized styrene-divinylbenzene polymer Reversed phase with strong hydrogen bond donor, acceptor, and dipolar character Fluoxetine, verapamil, olanzapine, tramadol, loratidine, and sumatriptane (81) verdanafil (82)... 

Sumatriptan is a 5HT (serotonin) agonist indicated in the treatment of migraine. Sumatriptan causes vasoconstriction and must therefore be used with caution in patients with coronary heart disease, such as angina. Concurrent administration of the agonist, sumatriptan and antagonists, such as fluoxetine, which is a selective serotonin re-uptake inhibitor, leads to increased CNS toxicity. 

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). 

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. ... 

Joffe RT, Sokolov STH. Co-administration of fluoxetine and sumatriptan the Canadian tx-pthencQ. ActaPsychiatrScand( 997) 95, 551-2. 

Szabo CP. Fluoxetine and sumatriptan possibly a counterproductive combination. J Clin... 

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