'triptan' drugs for migraine
NICE suggest that clinicians should:
- not offer SSRIs
- offer mirtazapine, trazodone, mianserin or reboxetine
A review of the use of triptans with SSRIs or SNRIs (2):
Triptans and SSRI or SNRI antidepressants - is there an interaction?
- using triptans (serotonin agonists) and SSRIs/SNRIs together might be expected to have additive effects on the serotonin system with potential to cause adverse effects
- In July 2006, the US FDA issued an alert based on a small number of reports of serotonin syndrome during concurrent use of these agents. All UK SmPCs for triptans and SSRIs/SNRIs warn of a possible interaction
- however, clinical experience indicates that combined use is normally uneventful. If clinically required, a triptan and SSRI/SNRI can be co-prescribed. Current advice (1) is to monitor for signs and symptoms of serotonin syndrome (e.g. restlessness, sweating, tremor, shivering) particularly when treatment is started, when doses are increased, or when another serotonergic medicine is added to the patient's regimen
- in theory, triptans with lower lipid solubility and a short half-life may be the safer choice (sumatriptan, rizatriptan or zolmitriptan). On the basis of the strength of warnings included in individual SmPCs, prescribers may prefer not to use:
- fluvoxamine with frovatriptan or zolmitriptan,
- citalopram with any triptan
- MHRA has advised that St John's wort (Hypericum perforatum), a herbal medicine used to treat depression, should not be taken with a triptan.
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