Is It Safe to Mix Triptans During a Migraine?

Health Professional

Full Question:

All of the printed instructions say not to take different triptans within 24 hours of each other, but my doctor says that's nonsense. What's the scoop on this? Thank you, Erika.

Full Answer:

Dear Erika:

One of the reasons that one triptan may work for us when another one doesn't, is that they each bind to create different combinations of serotonin receptors. If too many of the serotonin receptors are occupied at the same time, there's a risk of serotonin syndrome, a potentially nasty problem. This is compounded if we're also using other medications, such as antidepressants, that bind to serotonin receptors.

Another reason mixing triptans is generally not recommended is because it's easy to lose track of what we've taken and two doses of two triptans in the same day can be problematic. On the other hand, it's not uncommon to mix formulations of the same triptan. For example, if we take a sumatriptan (Imitrex) tablet, and it doesn't work, it's frequently recommended to then use a sumatriptan injection rather than another tablet.

This was reviewed in an article, Migraine Medications: Triptans, Antidepressants, and Serotonin Syndrome - Again. Take a look at that, then discuss the issue with your doctor again. Serotonin syndrome isn't "nonsense," and the warnings on triptans have merit, but all of our medications and all of our health issues need to be taken into account and weighed against the risks of serotonin syndrome.

Thanks for your question,
David Watson, MD, and Teri Robert

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About Ask the Clinician:

Dr. David Watson is a UCNS certified migraine and headache specialists and director of the Headache Center at West Virginia University. He and Lead Health Guide Teri Robert, team up to answer your questions about headaches and Migraines. You can read more about _ Dr. Watson _ or more about _ **Teri Robert

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