Duloxetine with Sumatriptan Interaction Details

Brand Names Associated with Duloxetine

Brand Names Associated with Sumatriptan

Medical Content Editor Dr. Brian Staiger, PharmD
Last updated Nov 11, 2023

Interaction Effect

Increased risk of serotonin syndrome

Interaction Summary

A life-threatening condition known as serotonin syndrome may occur when triptans, such as sumatriptan, are used in combination with a serotonin and norepinephrine reuptake inhibitor (SNRI), such as duloxetine. In a study of patients receiving coprescribed 5-hydroxytryptamine receptor agonists (triptans) and SSRI or SNRI antidepressants over 14 years, the risk of serotonin syndrome with concomitant use was determined to be 0 to 4 cases per 10,000 person-years of exposure . Symptoms of serotonin syndrome may include restlessness, hallucinations, loss of coordination, fast heart beat, rapid changes in blood pressure, increased body temperature, overreactive reflexes, nausea, vomiting, and diarrhea. Monitor patients who are prescribed this combination for symptoms , especially during treatment initiation and dose increases .

Severity

Major

Onset

Unspecified

Evidence

Theoretical

How To Manage Interaction

Coadministration of a triptan, such as sumatriptan, and a serotonin and norepinephrine reuptake inhibitor (SNRI), such as duloxetine, may result in a life-threatening condition called serotonin syndrome. Be aware that triptans may be commonly used intermittently and that either the triptan or the SNRI may be prescribed by a different physician. If these agents are used together, discuss the risks of serotonin syndrome with the patient and monitor closely for symptoms of serotonin syndrome (restlessness, hyperthermia, hyperreflexia, incoordination), especially during treatment initiation and dose increases.

Mechanism Of Interaction

Additive pharmacologic effects resulting in excessive serotonergic stimulation

Literature Reports

A) In a study of patients receiving coprescribed 5-hydroxytryptamine receptor agonists (triptans) and SSRI or serotonin norepinephrine reuptake inhibitor (SNRI) antidepressants over 14 years (n=19,017; total exposure=30,928 person-years), the risk of serotonin syndrome with concomitant use was determined to be 0 to 4 cases per 10,000 person-years of exposure. Using confirmed cases only (n=2) and confirmed cases plus possible cases (n=7), the risk of serotonin syndrome with concomitant use was 0.6 (95% CI, 0 to 1.5) and 2.3 (95% CI, 0.6 to 3.9) cases per 10,000 person-years of exposure, respectively. Throughout the study, a mean of 26% (range, 21% to 29%) of patients received triptan prescriptions, including sumatriptan, zolmitriptan, naratriptan, rizatriptan, eletriptan, almotriptan, or frovatriptan, with a coprescribed SSRI or SNRI antidepressant, including citalopram, fluvoxamine, escitalopram, paroxetine, fluoxetine, sertraline, duloxetine, or venlafaxine .

Duloxetine Overview

• Duloxetine is used to treat depression in adults and generalized anxiety disorder (GAD; excessive worry and tension that disrupts daily life and lasts for 6 months or longer) in adults and children 7 years of age and older. Duloxetine is also used to treat pain and tingling caused by diabetic neuropathy (damage to nerves that can develop in people who have diabetes) in adults and fibromyalgia (a long-lasting condition that may cause pain, muscle stiffness and tenderness, tiredness, and difficulty falling asleep or staying asleep) in adults and children 13 years of age and older. It is also used to treat ongoing bone or muscle pain such as lower back pain or osteoarthritis (joint pain or stiffness that may worsen over time) in adults. Duloxetine is in a class of medications called selective serotonin and norepinephrine reuptake inhibitors (SNRIs). It works by increasing the amounts of serotonin and norepinephrine, natural substances in the brain that help maintain mental balance and stop the movement of pain signals in the brain.

Sumatriptan Overview

• Sumatriptan is used to treat the symptoms of migraine headaches (severe, throbbing headaches that sometimes are accompanied by nausea or sensitivity to sound and light). Sumatriptan is in a class of medications called selective serotonin receptor agonists. It works by narrowing blood vessels in the head, stopping pain signals from being sent to the brain, and blocking the release of certain natural substances that cause pain, nausea, and other symptoms of migraine. Sumatriptan does not prevent migraine attacks or reduce the number of headaches you have.

Return To Our Drug Interaction Homepage

Feedback, Question Or Comment About This Information?

Definitions

Severity Categories

Contraindicated

These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.

Major

This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.

Moderate

This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.

Minor

While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.

Onset

Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.

Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.

Evidence

Level of documentation of the interaction.

Established: The interaction is documented and substantiated in peer-reviewed medical literature.

Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.

How To Manage The Interaction

Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.

It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.

Mechanism Of Interaction

The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.

Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.

Where Does Our Information Come From?

Information for our drug interactions is compiled from several drug compendia, including:

• Gold Standard Drug Database
• Micromedex
• Lexicomp
• DrugBank

The prescribing information for each drug, as published on DailyMED, is also used. 

Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.

The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.