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FDA Public Health Advisory
Combined Use of 5-Hydroxytryptamine Receptor Agonists
(Triptans), Selective Serotonin Reuptake Inhibitors (SSRIs) or
Selective Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs)
May Result in Life-threatening Serotonin Syndrome
List of Drug
Names
The FDA has important new safety information about taking
triptans (drugs used to treat migraine headaches) together with
certain types of antidepressant medicines. The antidepressant
medicines of concern are selective serotonin reuptake inhibitors (SSRIs)
and selective serotonin/norepinephrine reuptake inhibitors (SNRIs).
Names of the triptans, SSRIs and SNRIs are provided below.
A life-threatening condition called serotonin syndrome may occur
when triptans are used together with a SSRI or a SNRI.
Serotonin syndrome occurs when the body has too much serotonin, a
chemical found in the nervous system. Serotonin syndrome symptoms
may include restlessness, hallucinations, loss of coordination, fast
heart beat, rapid changes in blood pressure, increased body
temperature, overactive reflexes, nausea, vomiting, and diarrhea.
Serotonin syndrome may be more likely to occur when starting or
increasing the dose of a triptan, SSRI or SNRI.
The FDA has determined that serotonin syndrome occurs with combined
use of triptans and a SSRI or SNRI through reports describing
serotonin syndrome in people taking these medications together. Each
of these types of medicine increases serotonin levels on its own, as
well.
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, SSRI or SNRI should:
- keep in mind that triptans are often used intermittently and
that either the triptan, SSRI or SNRI may be prescribed by a
different physician
- 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
- instruct patients who take a triptan and an SSRI or SNRI
together to seek medical attention immediately if they experience
the symptoms of serotonin syndrome (described above).
Patients should know which medicines they take and tell all of
their healthcare providers (physicians, nurses, and pharmacists)
what these medicines are.
Triptans are drugs used to treat migraine headaches, and SSRIs and
SNRIs are drugs used to treat depression and other mood disorders.
The FDA has requested that all manufacturers of triptans, SSRIs and
SNRIs update their prescribing information to warn of the
possibility of serotonin syndrome when triptans and SSRIs or SNRIs
are taken together.
Drug Names
SSRIs and a Combination
Drug Containing an SSRI |
SNRIs |
Triptans |
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*Sibutramine (Meridia), a drug approved for weight loss but not depression, is a SNRI and should therefore be used with caution with triptans and other serotonergic drugs. Sibutramine label 
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Date created: July 19, 2006, updated November 24, 2006 |
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