Venlafaxine Triptans

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

The SSRIs normally appear not to interact with the triptans, but there are a few rare cases of dyskinesias when sumatriptan was given with an SSRl, and there is some evidence to surest that the serotonin syndrome may occasionally develop. Venlafaxine and duloxetine are predicted to interact similarly. Fluvoxamine modestly inhibits the metabolism of frovatriptan, and may inhibit the metabolism of zolmitriptan. 

Theoretically the metabolism of venlafaxine may be inhibited by CYP2D6 inhibitors or substrates such as diphenhydramine, melperone, quinidine or thioridazine. CYP3A4 inhibitors such as ketoconazole may also have some effect. An isolated case describes a hypertensive crisis associated with venlafaxine and di-sulfiram. The manufacturers predict that the use of triptans with venlafaxine may have additive effects on serotonin, which could lead to the serotonin syndrome. 

The manufacturers caution the use of drugs that affect serotonergic transmission, such as the triptans. This is because of the possible risks of the serotonin syndrome. For more about the serotonin syndrome see Additive or synergistic interactions , (p.9). This interaction has been seen, rarely, to occur with a number of other serotonergic drugs and venlafaxine, which gives weight to this prediction. 

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