FDA Warns on Mixing Antidepressants with Migraine Drugs

Mixing common migraine drugs such as Imitrex (sumatriptan) with antidepressants like Prozac (fluoxetine) or Cymbalta (duloxetine) can trigger a life-threatening condition called serotonin-syndrome, the FDA has warned.

In a public health advisory, the FDA also asked all makers of triptans, selective serotonin reuptake inhibitors (SSRIs), and serotonin/norepinephrine reuptake inhibitors (SNRIs) to update prescribing information to warn of the possibility of serotonin syndrome when triptans (5-hydroxytryptamine receptor agonists), SSRIs, or SNRIs are taken together.

Serotonin-syndrome is characterized by rapid heart beat, sudden changes in blood pressure, and increased body temperature. Other symptoms include restlessness, hallucinations, loss of coordination, overactive reflexes, nausea, vomiting, and diarrhea.

Patients with these symptoms when taking these drugs should seek immediate medical care, the FDA said.

The FDA issued the warning after receiving reports of serotonin syndrome among patients mixing triptans and SSRIs or SNRI.

According the FDA the risk may be greater when initiating this drug combination or when changing dose of one of the drugs.

The FDA said patients who are taking a triptan along with an SSRI or SNRI should talk to their doctor before stopping their medications.

Physicians prescribing a triptan with a SSRI or SNRI should:

- Keep in mind that triptans are often used intermittently and that the triptan, SSRI or SNRI may be prescribed by different physicians.
- Weigh the potential risk of serotonin syndrome with the expected benefit of using a triptan with an SSRI or SNRI.
- Discuss the possibility of serotonin syndrome with patients if a triptan and an SSRI or SNRI will be used together.
- Follow patients closely if a triptan and an SSRI or SNRI are used together, particularly during treatment initiation, with dose increases, or with the addition of another serotonergic medication.

SSRIs included in the warning were Celexa (citalopram), Fluvoxamine (generic), Lexapro (escitalopram), Paxil (paroxetine), Prozac (fluoxetine) Symbyax (olanzapine/fluoxetine) and Zoloft (sertraline).

SNRIs were Cymbalta (duloxetine) and Effexor (venlafaxine).

Triptans were Amerge (naratriptan), Axert (almotriptan), Frova (frovatriptan), Imitrex (sumatriptan) Maxalt and Maxalt-MLT (rizatriptan), Relpax (eletriptan), and Zomig and Zomig ZMT (zolmitriptan).

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