Triptans SSRIs

FDA, Combined Use of 5-Hydroxytryptamine Receptor Agonists (Triptans), Selective Serotonin Reuptake Inhibitors (SSRIs) or Selective Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs) May Result in Life-Threatening Serotonin Syndrome , FDA Public Health Advisory (2006) http //www.fda.gov/Cder/Drug/advisory/ S SRI S S200607.htm... 

A life-threatening condition, when selective serotonin reuptake inhibitors (SSRIs) and 5-hydroxytryptamine receptor agonists (triptans) are used together. However, many other drugs have been implicated (see below). Signs and symptoms of serotonin syndrome include the following ... 

MAOIs, TCAs, SSRIs, SNRIs, mirtazapine, venlafaxine Amphetamines, phentermine, methylphenidate, sibutramine Triptans... 

Drugs used in the treatment of acute migraine, such as sumatriptan and rizatriptan, are 5-HTiB/iD-receptor agonists and could theoretically interact pharmacodynami-cally with SSRIs to cause serotonin toxicity. Triptans are metabolized mainly by monoamine oxidase, which makes pharmacokinetic interactions with SSRIs unlikely. Although case series have suggested that sumatriptan can be safely combined with SSRIs (SEDA-22, 14), there are occasional reports of 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). 

Treatment of 12 healthy volunteers with paroxetine (20 mg/day for 14 days) did not alter the pharmacokinetics or pharmacodjmamic effects of an acute dose of rizatriptan (10 mg orally) (32). These data are reassuring, but it is possible that sporadic cases of 5-HT neurotoxicity could stiU occur when a triptan is combined with an SSRI. 

HT agonists (Triptans) The SSRIs normally appear not to interact with the triptans, but there are a few rare cases of dyskinesias and there is some evidence to suggest that the serotonin syndrome may occasionally develop. 

Not understood. SSRIs increase the levels of 5-HT (serotonin) at post-syn-aptic receptors. In theory the triptans (5-HTi agonists) might possibly add... 

---