Side Effects. Many of the newer triptans may have fewer severe side effects than sumatriptan. Side effects of most triptans, however, can include:
- Tingling and numbness in the toes
- Sensations of warmth
- Discomfort in the ear, nose, and throat
- Nausea
- Drowsiness
- Dizziness
- Muscle weakness
- Heaviness, pain or both in the chest. (About 40% of patients taking sumatriptan experience these symptoms and they are major factors in discontinuing the drug. Newer drugs, such as almotriptan, produce fewer chest symptoms.)
- Rapid heart rate
Complications of Triptans. The following are potentially serious problems.
- Complications of Heart and Circulation. Triptans narrow (constrict) blood vessels. Because of this effect, spasms in the blood vessels may occur and cause serious side effects, including stroke and heart attack. Such events are rare, but patients with an existing history or risk factors for these conditions should generally avoid triptans.
- Serotonin Syndrome. Serotonin syndrome is a life-threatening condition that occurs from an excess of the brain chemical serotonin. Triptan drugs used to treat migraine, as well as certain types of antidepressant medications, can increase serotonin levels. These antidepressant drugs include serotonin reuptake inhibitors (SSRIs) -- such as fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft) -- and selective serotonin/norepinephrine reuptake inhibitors (SNRIs), such as duloxetine (Cymbalta) and venlafaxine (Effexor). It is very important that patients not combine a triptan drug with a SSRI or SNRI drug. Serotonin syndrome is most likely to occur when starting or increasing the dose of a triptan or antidepressant drug. Symptoms include restlessness, hallucinations, rapid heartbeat, tremors, increased body temperature, diarrhea, nausea, and vomiting. You should seek immediate medical care if you have these symptoms.
The following groups should avoid triptans or take them with caution and only with the advisement of a doctor:
- Anyone with a history or with any risk factors for stroke, uncontrolled diabetes, high blood pressure, or heart disease.
- People taking antidepressants that increase serotonin levels.
- Children and adolescents. They may be safe, but controlled studies are needed to confirm this. (Triptans should not, in any case, be the first-line treatment for children.)
- People with basilar or hemiplegic migraines. (Triptans are not indicated for these migraineurs.)
- There is no evidence to date of any higher risk for birth defects in pregnant women who take triptans. Still, women should be cautious about taking any medications during pregnancy and discuss any possible adverse effects with their doctors.
Previous Section
