Venlafaxine with Naratriptan Interaction Details
Brand Names Associated with Venlafaxine
- Effexor®
- Effexor® XR
- Venlafaxine
Brand Names Associated with Naratriptan
- Amerge®
- Naratriptan
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 12, 2023
Interaction Effect
An increased risk of serotonin syndrome
Interaction Summary
Cases of serotonin syndrome have been reported with coadministration of a 5-hydroxytryptamine receptor agonist (triptan), such as naratriptan, and a serotonin norepinephrine reuptake inhibitor (SNRI), which may be life-threatening. In a study of patients receiving coprescribed 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 closely for symptoms . Discontinue use of naratriptan if serotonin syndrome is suspected ..
Severity
Major
Onset
Delayed
Evidence
Probable
How To Manage Interaction
Cases of serotonin syndrome have been reported with coadministration of a 5-hydroxytryptamine receptor agonist (triptan), such as naratriptan, and a serotonin norepinephrine reuptake inhibitor (SNRI), which may be life-threatening. Symptoms may occur within minutes to hours of initiation of a new or increased dose of a serotonergic medication. 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 closely for symptoms . Discontinue use of naratriptan if serotonin syndrome is suspected .
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 .
Venlafaxine Overview
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Venlafaxine is used to treat depression. Venlafaxine extended-release (long-acting) capsules are also used to treat generalized anxiety disorder (GAD; excessive worrying that is difficult to control), social anxiety disorder (extreme fear of interacting with others or performing in front of others that interferes with normal life), and panic disorder (sudden, unexpected attacks of extreme fear and worry about these attacks). Venlafaxine 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.
Naratriptan Overview
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Naratriptan is used to treat the symptoms of migraine headaches (severe, throbbing headaches that sometimes are accompanied by nausea and sensitivity to sound or light). Naratriptan is in a class of medications called selective serotonin receptor agonists. It works by narrowing blood vessels around the brain, stopping pain signals from being sent to the brain, and stopping the release of certain natural substances that cause pain, nausea, and other symptoms of migraine. Naratriptan 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.