Clinical Question

[nikei3ball]

I have a question for my clinical class:

Patient is taking citalopram & alprazolam for anxiety. Patient has migraines (may be drug induced). I need to reccomend pharmacotherapy regimen for migraines (severe). Need to give ergotamine or a triptan because that's first line therapy, but sets up for a serotonin syndrome with the anxiolytics. What do you do in this case?

---

Members don't see this ad.

 

[WVUPharm2007]

I've always wondered how common that interaction between the SSRIs and the selective seratonin agonist triptans was. I clearly remember several patients recieving SSRIs and Imitrex at the same time...never seemed to harm them.

 

[Priapism321]

I have a question for my clinical class:

Patient is taking citalopram & alprazolam for anxiety. Patient has migraines (may be drug induced). I need to reccomend pharmacotherapy regimen for migraines (severe). Need to give ergotamine or a triptan because that's first line therapy, but sets up for a serotonin syndrome with the anxiolytics. What do you do in this case?

First of all, you don't "need" to give those agents simply because they are first line therapy. You'd certainly like to give first line therapy, but you "need" to make sure the patient will be put on the safest regimen possible to alleviate her debilitating condition. There are several other factors that must be considered for anyone to give a meaningful response to your inquiry (age, comorbidities, renal function, etc.).

 

[Priapism321]

I've always wondered how common that interaction between the SSRIs and the selective seratonin agonist triptans was. I clearly remember several patients recieving SSRIs and Imitrex at the same time...never seemed to harm them.

They probably weren't hanging out at the local Rite-Aid when they became tachycardic, hyperthermic, and began to hallucinate.

http://www.fda.gov/CDER/DRUG/infosheets/hcp/triptanshcp.htm

Wooltorton E. CMAJ 2006 Oct 10;175:874-875.

 

[CaliCPhT]

I've always wondered how common that interaction between the SSRIs and the selective seratonin agonist triptans was. I clearly remember several patients recieving SSRIs and Imitrex at the same time...never seemed to harm them.

I know this is an old thread, but I too was wondering how common serotonin syndrome is. I also saw that there was a risk of it when taking an SSRI in combination with tramadol. What causes this interaction?

 

[WVUPharm2007]

They probably weren't hanging out at the local Rite-Aid when they became tachycardic, hyperthermic, and began to hallucinate.

http://www.fda.gov/CDER/DRUG/infosheets/hcp/triptanshcp.htm

Wooltorton E. CMAJ 2006 Oct 10;175:874-875.

Yeah, yeah, but I wonder how *common* it is as a percentage or maybe a nice RR ratio. The computers don't even pick it up as an interaction, either. (At least when I was at Kroger last) You'd cal the prescriber and they'd blow it off like it's nothing. 15 bad cases and 27 total cases appears rare...but who knows how many actually take both concurrently and how many aren't reported or are misdiagnosed, etc, etc....

I wonder how many people are depressed about having migraines.

 

[dgroulx]

Yeah, yeah, but I wonder how *common* it is as a percentage or maybe a nice RR ratio. The computers don't even pick it up as an interaction, either. (At least when I was at Kroger last) You'd cal the prescriber and they'd blow it off like it's nothing. 15 bad cases and 27 total cases appears rare...but who knows how many actually take both concurrently and how many aren't reported or are misdiagnosed, etc, etc....

I wonder how many people are depressed about having migraines.

WAGS system catches it as a MAJOR interaction (in big red letters). When I phone the MD, they also blow it off. So, I select "prescriber consulted" when I override, or "reviewed profile" if it is one that I checked on before. I'm sure that serotonin syndrome is rare, I just make sure that I cover my ass.

 

[pharmacogenomic]

In this population they sometimes tend to get tachycardic, hyperthermic & have hallucinations (altho more vocal & aural than visual).

So....when counseling, you'd want to advise about any NEW or increased frequency of sx.

I agree with what was said a month ago....if there is hx the migraines might be drug induced, we need more hx on the pt.