Migraine Medication (cont.)

What are the warnings and precautions with migraine medications?

In 2006, the FDA warned about combining triptan drugs with selective serotonin reuptake inhibitors (SSRIs) and selective norepinephrine reuptake inhibitors (SNRIs). Taking the drugs together could result in an overload of serotonin in the body, creating what is known as the "serotonin syndrome.” Symptoms of this life-threatening condition include rapid increase in blood pressure, fast heart beat, and increased body temperature.

SSRIs include:

• Citalopram (Celexa)
• Escitalopram (Lexapro)
• Fluoxetine (Prozac)
• Fluvoxamine (Luvox)
• Olanzapine/fluoxetine (Symbyax)
• Paroxetine (Paxil)
• Sertraline (Zoloft)

SNRIs include:

• Duloxetine (Cymbalta)
• Sibutramine (Meridia)
• Venlafaxine (Effexor)

Ergot alkaloids should not be used concurrently with drugs that inhibit a certain liver enzyme. Doing so could result in a life-threatening decrease in blood flow to the extremities and/or brain. These drugs include:

• Macrolide antibiotics such as erythromycin (Benzamycin, Emgel, Ilotycin), clarithromycin (Biaxin, Biaxin XL), and troleandomycin (Tao)
• HIV protease inhibitors such as ritonavir or indinavir
• Azole antifungals such as ketoconazole

Use of topiramate (Topamax) can result in decreased sweating and increased body temperature. This may be especially important during hot weather. Wearing light clothes and drinking plenty of fluids while using topiramate during warmer months is very important. A physician should be consulted if body temperature rises.

Divalproex (Depakote ER, Depakote Sprinkle Capsules, Depakote) should not be used in patients with liver or pancreatic disease.

SOURCES:
American Headache Society (www.AmericanHeadacheSociety.org)
National Migraine Association (www.migraines.org)
National Headache Foundation (www.headaches.org)
Medline Plus (www.nlm.nih.gov/medline)
Annals of Allergy, Asthma and Immunology, 9 January 2006 (found on www.researchgate.net)
Migraine Research Foundation (www.migraineresearchfoundation.org)
Food and Drug Administration (www.fda.gov)
WebMD (www.WebMD.com)
Kaiser Permanente Drug Encyclopedia (www.kaiserpermanente.org)

Last Editorial Review: 8/17/2009