Triptans Alone Could Cause Life-Threatening Condition

In 2006, 38 cases of serotonin syndrome associated with triptans (Imitrex, Maxalt, etc). Out of them, "27 were in patients taking the headache drugs and antidepressants and 11 in people taking headache drugs alone," said Offie Soldin, an associate professor at Georgetown University Medical Center in Washington who conducted a new study for FDA. This study is the first to use the FDA Adverse Event Reporting System which is a fancy name for a database that monitors all drugs and therapeutic biologic products after they have been FDA-approved.

It's a well known fact that if one is on Valiums or Prozacs or whatever similar drugs that are out there that play a number on one's serotonin level, one should be careful with triptans. There even was an FDA warning about it in 2006. At least it's supposed to be. Many a doctor prescribe both antidepressants and triptans to migraine patients without as much as butting an eyelash.

That particular nuisance aside, this is the first time someone publicized the cases of serotonin syndrome from triptans alone. "In the 11 reports of serotonin syndrome, five patients were hospitalized and two cases were classified as life threatening," said study.

Considering the origins of the triptans as LSD derivatives, that comes as small surprise. It is, however, a good reminder to us all that triptans are a serious medicine that's has to be taken carefully and if there's any notable after-effects, one has to pay close attention to them. Here's a short primer on what to be on look-out for:

Mild symptoms of serotonin syndrome include Mild symptoms may only consist of tachycardia, and shivering, diaphoresis (sweating commonly associated with shock), mydriasis (dilated pupils), myoclonus (intermittent tremor or twitching), as well as overactive or overresponsive reflexes. In addition moderate intoxication includes abnormalities such as hyperactive bowel sounds, hypertension and hyperthermia; a temperature as high as 40 °C (104 °F) is common in moderate intoxication. The overactive reflexes and clonus in moderate cases may be greater in the lower limbs than in the upper limbs. Mental status changes include hypervigilance and agitation.

Severe symptoms include severe hypertension and tachycardia that may lead to shock. Severe case often have agitated delirium as well as muscular rigidity and high muscular tension. Temperature may rise to above 41.1 °C (105.98 °F) in life-threatening cases. Other abnormalities include metabolic acidosis, rhabdomyolysis, seizures, renal failure, and disseminated intravascular coagulation.

(source: wikipedia.com, serotonin syndrome, symptoms)

So, not to OD on LSD, do watch out for the above-mentioned abnormalities, my gentle readers.

link: Migraine Medicines May Cause Potentially Deadly Brain Syndrome

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What Your Doctor Doesn't Know Might Hurt You

Lets imagine a hypothetical scenario - a migraine patient is prescribed a Triptan (Imitrex, Frove, etc), a birth-control pill and some anti-depressants like Amitriptyline (Elavil, Tryptanol) or Zoloft, Prozac or Paxil. Anti-depressants are often used as an off-label prescription for migraine headaches, nothing unusual here.

How many of you take a similar combination of prescription meds? Quite a few, I would imagine. Have you ever wondered how those drugs affect you, what they actually do to help you with your migraines?

The answer is simple - they all regulate re-uptake of Serotonin. It's a substance your body creates to keep your nervous system in balance. Low levels of Serotonin might cause panic attacks, depression and other serious neurological disorders. If that's not enough, it also might cause migraines. Triptans, some birth-control pills and anti-depressants all have the ability to regulate the level of serotonin and might help to abort or prevent migraines.

Now, back to the original question - do your doctors know exactly how those drugs work? Would they be prescribing you this mix if they understood the mechanics of serotonin balance?

Probably not. In July 2006, FDA issued a warning that mixing Triptans with anti-depressant might result in serotonin syndrome, "a life-threatening condition that occurs when there's too much of the chemical serotonin in your blood".

It's sort off like OD'ing on LSD minus the fun part.

On top of that, the Pill you are taking might also be pulling at serotonin levels when you least expect it. "Serotonin is affected by hormones. An increase in the female hormone estrogen triggers an increase in serotonin. Birth control pills containing estrogen produce headaches when serotonin levels fall in pill free days. (A drop in estrogen levels during menstruation produces a decrease in serotonin, which can bring on migraine because blood vessels dilate.)"

If you have more than a couple of migraine attacks a month and you take all 3 of the above-mentioned groups of medications, it might be time to seek a second opinion. After all, your migraines are not getting better, are they?

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Manage your migraines as you manage the rest of your life - with Prozac

In case kitten pictures didn't do the trick, here's a little article to help wash out the bad taste left over from CNN's postings earlier on.

Doctor Jerry Swanson speaks of "migraine management" in some lengths on the pages of chicagotribune.com ; kudos to good doctor for mentioning alternative treatments such as Botox injections rather matter-of-factly. Lets hope our physicians would get that open-minded in a hurry.

He also mentions antidepressants, anti-seizure medications and cardiovascular drugs as preventives. If your current doctor is reluctant to let you have a go at some of these, link her up, let her read what the experts are saying.

Overall a competent write-up, if limited. I would have preferred Dr. Swanson go into more details on the preventives besides mentioning some general categories. Don't make us post another kitten picture, doctor, to cover up the lack of information. No matter how much damage it will cause to the inter-webs, we are not afraid to do it.


link: With migraines, think management, not cure