PUBLIC HEALTH ADVISORY: Migraine Drugs, Antidepressants May Cause Life-Threatening Interactions

The Food and Drug Administration (FDA) issued a public health advisory on July 19 warning consumers about the possibility of life-threatening reactions — such as nausea, changes in blood pressure or hallucinations — that may be caused by the interaction of migraine headache drugs, called “triptans,” and certain antidepressants.

When triptans are taken in combination with antidepressants known as selective serotonin reuptake inhibitors (SSRIs) or selective serotonin/norepinephrine reuptake inhibitors (SNRIs), a condition called serotonin syndrome may result. The table accompanying this article lists the triptans, SSRIs, and SNRIs currently marketed in the United States.

Serotonin syndrome develops when the body is exposed to too much of the naturally occurring chemical serotonin. Serotonin is found in the brain, blood and gastrointestinal tract. The combination of triptans, SSRIs and SNRIs can increase serotonin to extremely high levels that could result in serotonin syndrome.

The following are the symptoms that may be seen with the serotonin syndrome:

• restlessness
• hallucinations
• loss of coordination
• rapid heartbeat
• rapid changes in blood pressure
• increased body temperature
• overactive reflexes
• nausea, vomiting and diarrhea

The FDA has requested that all producers of triptans, SSRIs and SNRIs update their professional product labels, or professional package inserts, to warn physicians and pharmacists of the possibility of serotonin syndrome when these drugs are taken together.

The FDA’s move would still leave consumers in the dark about these potentially life-threatening drug interactions. Information about the possibility of serotonin syndrome should be included in medication guides, which consumers must receive whenever SSRIs and SNRIs are dispensed. In addition, Medication Guides should be distributed whenever triptans are prescribed to warn consumers about drug interactions that may lead to serotonin syndrome.  

All SSRIs and SNRIs are now required to be dispensed with FDA-approved written drug information for consumers called Medication Guides. The Medication Guides for SSRIs and SNRIs warn of an increased risk of suicide with the use of these drugs. Information about the possibility of the serotonin syndrome should be added to these Medication Guides. In addition, Medication Guides should be required for all triptans warning consumers about the drug interactions that may lead to serotonin syndrome.

What You Can Do

DO NOT stop taking any antidepressant drug without first consulting your physician.

If you are taking triptans, SSRIs or SNRIs and experience the symptoms of serotonin syndrome previously listed above, you should seek medical attention immediately.