Sumatriptan interactions to avoid

Drug interactions | Food interactions | Other interactions | Avoiding interactions | When to see a doctor

Sumatriptan, marketed under the brand name Imitrex, is a triptan approved by the Food and Drug Administration (FDA) for treating migraines, with or without aura. It works by attaching to serotonin receptors in the brain. This narrows blood vessels in the head and blocks the release of substances that cause inflammation. Sumatriptan is available in several forms, including a tablet, injection, nasal powder, and nasal spray. The sumatriptan injection can also be used to treat cluster headaches. 

Although it is an effective treatment option for migraines, sumatriptan can interact with several drugs. These interactions can result in serious adverse effects, such as high blood pressure. Read on for more drug information and to learn more about which drugs sumatriptan can interact with and how to minimize the risk of interactions. 

Related: Sumatriptan dosage | Sumatriptan side effects

Sumatriptan drug interactions

Sumatriptan interacts with various medications, including drugs that increase serotonin levels and certain antidepressants. These interactions increase the risk of serious side effects. Read on to learn about some of the most common sumatriptan drug interactions.

Medications that increase serotonin levels

Serotonin syndrome is a rare but serious condition that occurs when serotonin levels reach high levels in the body. Serotonin syndrome may happen if you take more than one medication that increases serotonin levels, if you take too much of a medication that increases serotonin levels, or if the dose of a medication that increases serotonin levels is raised. Symptoms can come on very quickly, and in some cases, they may become severe. Examples of symptoms include high blood pressure, fever, confusion, agitation, stiff muscles, and anxiety. If you develop any symptoms of serotonin syndrome, get emergency medical help immediately. 

Sumatriptan increases serotonin levels. Therefore, taking it with other medicines that raise serotonin increases the risk of serotonin syndrome. Other types of prescription drugs that are known to increase serotonin in the body are selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and tricyclic antidepressants (TCAs). 

Specific examples of drugs that increase serotonin levels include: 

• Amitriptyline
• Silenor (doxepin)
• Fentanyl
• Lithium carbonate
• Ultram (tramadol)
• Buspirone
• Dexedrine (dextroamphetamine sulfate extended-release)
• Tryptophan
• Prozac (fluoxetine)
• Effexor (venlafaxine)
• Luvox (fluvoxamine maleate)
• Cymbalta (duloxetine)
• Paxil (paroxetine)
• Zoloft (sertraline) 

Medications that contain ergot

It’s recommended to avoid using sumatriptan with any drugs that contain ergot within 24 hours of each other. Sumatriptan works by narrowing blood vessels. Ergot-containing drugs can also narrow blood vessels throughout the body. Therefore, taking these medications together can cause the blood vessels to narrow too much, which raises the risk of serious side effects such as heart attack, stroke, blindness, tissue death, and Raynaud’s syndrome. 

Examples of ergot-containing drugs include:

• Ergomar (ergotamine)
• Dihydroergotamine
• Methysergide
• Ergoloid mesylate
• Migergot (ergotamine/caffeine)

Monoamine oxidase inhibitors (MAOIs)

Monoamine oxidase inhibitors (MAOIs) are a class of drugs that are prescribed for conditions such as depression and Parkinson’s disease. While they can be an effective treatment option, they aren’t commonly used because they require strict dietary restrictions and can interact with several medications, including sumatriptan. 

Sumatriptan should never be taken with or within 14 days of certain MAOIs, including isocarboxazid, phenelzine, and tranylcypromine. Mixing these drugs can significantly increase the levels of sumatriptan in the body, which can lead to serious side effects. This combination of drugs can also increase your risk of serotonin syndrome. 

Other triptans

Avoid taking another triptan within 24 hours of taking sumatriptan, and vice versa. Triptans work by narrowing blood vessels. Taking multiple triptans in a short period can compound the drugs’ effects, which can cause the blood vessels to narrow too much. Similar to other interactions mentioned above, this can result in serious side effects such as heart attack, stroke, blindness, tissue death, and Raynaud’s syndrome. 

Examples of other triptans include:

• Zomig (zolmitriptan)
• Relpax (eletriptan)
• Frova (frovatriptan)
• Maxalt (rizatriptan)

Sumatriptan food interactions

Luckily, there are no known foods that interact with sumatriptan. Keep in mind that sumatriptan can be taken with or without food. 

Nevertheless, certain foods can act as a trigger for migraines. Avoiding these foods may help lower the frequency or severity of migraine attacks. Examples include processed meats, citrus fruits, and gluten. On the other hand, increasing your consumption of water, leafy green vegetables, and fatty fish, such as salmon or tuna, may help prevent migraines. 

Other sumatriptan interactions

Sumatriptan doesn’t interact with any specific beverages, but alcohol and caffeine may be triggers for migraines. There are also certain health conditions and dietary supplements that may interact with sumatriptan. 

Sumatriptan and alcohol

While alcohol doesn’t interact directly with sumatriptan, it’s probably best to limit or avoid alcohol if you’re suffering from migraines. Alcohol is one of the most common triggers for migraines, especially in dark or bubbly varieties. It’s best to discuss alcohol consumption with your healthcare provider. But if you do decide to drink alcohol, vodka is the least likely to cause migraines.

Sumatriptan and caffeine

Similar to alcohol, caffeine doesn’t interact directly with sumatriptan. However, excessive amounts can trigger a migraine. On the other hand, caffeine withdrawal may also bring on a headache. It might be difficult to find the right balance, but it’s safe to say that if you consume large amounts of caffeine daily, you may want to consider gradually lowering your intake. 

Sumatriptan and disease

Some medical conditions can increase the risk of side effects from sumatriptan. Doctors won’t prescribe sumatriptan if you have certain health conditions. Healthcare professionals must know your complete medical history to discuss the risks and benefits of taking sumatriptan. If it is prescribed, you may require close monitoring. 

Some of these conditions include, but are not limited to: 

• Heart disease
• Wolff-Parkinson-White syndrome or other electrical problems in the heart
• History of stroke, transient ischemic attack (TIA), hemiplegic migraine, or basilar migraine
• Peripheral vascular disease
• Ischemic bowel disease
• Unmanaged high blood pressure
• Severe liver disease
• History of seizures

People who are pregnant or breastfeeding should always discuss the use of any medications with their provider. It’s not known if it’s safe to take sumatriptan while pregnant or breastfeeding. However, research has shown that sumatriptan can pass into breast milk.

Sumatriptan and herbal supplements

St. John’s wort is an herbal supplement that is often used for depression. Like sumatriptan, St. John’s wort can increase serotonin levels in the body. Like other interactions mentioned above, taking these medications together can compound this effect, which increases the risk of serotonin syndrome. 

How to minimize sumatriptan interactions

To minimize sumatriptan interactions, it’s essential to keep an updated list of your medical conditions and all prescription and over-the-counter (OTC) medications, vitamins, and herbal supplements you take. Share this list with your healthcare providers so they can screen for interactions before prescribing a new medication, like sumatriptan. While some interactions only require close monitoring, others may need dose adjustments. Some interactions may require discontinuation of therapy altogether. 

Take note of any new side effects, new or worsening symptoms of your condition, or changes in the effectiveness of your medications. These can be signs of a sumatriptan interaction and should be reported to your doctor. 

When to talk to a healthcare provider about sumatriptan interactions

The best time to discuss sumatriptan interactions with your provider is before you start the drug. This way, they can identify any possible interactions before they occur. This ensures proper management and monitoring during sumatriptan therapy. 

Remember that while this article reviews common sumatriptan interactions, it doesn’t provide a complete list. There may be other sumatriptan interactions not discussed here, so always consult a healthcare professional for medical advice regarding drug interactions.