Sumatriptan with Dihydroergotamine Interaction Details
Brand Names Associated with Sumatriptan
- Imitrex® Tablets
- Sumatriptan
- Treximet® (as a combination product containing Naproxen, Sumatriptan)
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 11, 2023
Interaction Effect
Prolonged vasospastic reactions
Interaction Summary
Concurrent use of sumatriptan and an ergot-containing drugs may cause an additive vasospastic reaction. One case has been reported where concurrent use of ergotamine and sumatriptan was associated with cerebellar infarction in a 24-year-old female with no evidence of vascular anomaly . Another case report describes the sudden death of a 58-year old female who had been prescribed both methysergide and sumatriptan . Use of sumatriptan within 24 hours of an ergot preparation, such as dihydroergotamine, is contraindicated .
Severity
Contraindicated
Onset
Rapid
Evidence
Theoretical
How To Manage Interaction
Use of sumatriptan within 24 hours of an ergot preparation, such as dihydroergotamine, is contraindicated.
Mechanism Of Interaction
Additive vasoconstrictive effects
Literature Reports
A) A 24-year-old migraine patient suffered a cerebellar infarction after concurrent use of ergotamine and sumatriptan . The CT scan found no vascular anomalies. Early symptoms included ataxia, dizziness, bradycardia, sweating, and vomiting. The patient later became aphasic and then unresponsive. Because the patient was young, otherwise healthy, and had no vascular anomalies, the infarction was likely the result of an interaction between sumatriptan and ergotamine.
B) Thirty-eight patients were pretreated with dihydroergotamine, followed by sumatriptan 2 or 4 mg subcutaneously . While dihydroergotamine alone caused 13 and 9 mm Hg maximal increases in systolic and diastolic blood pressures, respectively, sumatriptan alone caused 7 and 6 mm Hg increases in these values. Treatment with both drugs resulted in changes no different than those observed with either drug alone.
C) A 58-year old female who had been taking methysergide prophylactically for seven years was on her annual break from the drug when she experienced a migraine headache. She took a dose of sumatriptan and developed chest pain and vomiting within three hours, with the outcome being fatal. The time frame between the doses of methysergide and sumatriptan is not specified. The female had also been recently diagnosed with rheumatic mitral stenosis, and ischemic heart disease was revealed during autopsy .
Sumatriptan Overview
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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.
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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:
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.