Experts Quarrel with FDA about SSRI?Triptan Effects
ORLANDO?Nearly 4 in 5 (79%) migraine sufferers are taking at least 1 concurrent medication that is not directly related to their migraine. When it comes to migraine treatment, especially with newer medications, few drug interaction problems should worry physicians, suggested experts at a seminar presented by the Diamond Headache Clinic Research and Educational Foundation at Headache Update 2006.
Even so, physicians often hear about "potential" interactions from pharmacists and patients, and they need to be up on the latest information to separate fact from fiction, said Timothy R. Smith, MD, RPh, medical director, Ryan Headache Center, St. Louis.
Although some theoretical concerns have been reported in the literature, the most common associated with combining selective serotonin reuptake inhibitors (SSRIs) and triptans, such concerns may not be well founded, Dr Smith told .
"It was a theoretical concern when the clinical trials first started with the triptan drugs, since these drugs affect serotonin receptors in blood vessels. There was a concern that if you combine that kind of medication with a drug that increases concentration of serotonin, that kind of combination would be bad," he said. "Such serotonin syndrome has been observed in some psychiatric populations and among Parkinson's patients who use medications that can cause this problem. But it has not been identified to any extent in migraine populations."?
Nevertheless, physicians may still encounter patients who have been advised by their pharmacist not to take an SSRI and a triptan together. "It's important to know about this?the real story of these combinations?so that doctors can know how to educate the patients and how to respond to these questions from the pharmacy," Dr Smith explained.
The multitude of new drugs and data makes it difficult to keep abreast. Dr Smith recalled that when he finished pharmacy school in 1983, 6 new drugs were introduced to the market. Today, >150 new drugs are added to the pharmacopeia every year.
Much of the information on new drugs is computerized, and as prescriptions are being filled, potential interactions will cause a red light to go on. But these alerts are not always correct, according to Dr Smith.?
For example, SSRIs and migraine medications can be taken together safely in responsible doses, if the doctor is following the patient and is aware of the situation. "The incidence of side effects from combining these drugs is extremely small and almost ignorable." He offered this advice to physicians: "Know your drugs. Know what you are prescribing. We need to get the word out about this sort of issue and help physicians to be better in responding to questions that come up."
After the meeting, the FDA announced that it was now requiring all triptan manufacturers to place?precautionary language?on their prescribing labels describing the possibility of serotonin syndrome in patients who combine triptans and SSRIs. According to the agency, >20?cases of serotonin syndrome have been reported, 2 of which were considered potentially life-threatening.
US Migraine Prevalence
About 30 million Americans suffer from migraine headaches regularly. A study of the prevalence of migraine in the United States (Headache. 2001; 41:646-657) showed that 18.2% of females and 6% of males in this country (all aged >12 years) have migraines. The prevalence was higher in whites than in blacks and was inversely associated with household income.