• Home
  • Store
    • Newsletter Subscriptions
    • Multimedia Subscriptions
    • Books
    • eBooks
    • ABPN SA Courses
  • CME Center
  • Multimedia
    • Podcast
    • Webinars
    • Blog
  • Newsletters
    • General Psychiatry
    • Child Psychiatry
    • Addiction Treatment
    • Hospital Psychiatry
    • Geriatric Psychiatry
  • Log In
  • Register
  • Welcome
  • Sign Out
  • Subscribe
Home » Serotonin Syndrome Risks With Co-Prescription of Triptan Drugs and SSRIs or SNRIs

Serotonin Syndrome Risks With Co-Prescription of Triptan Drugs and SSRIs or SNRIs

September 1, 2018
Adam Strassberg, MD.
From The Carlat Psychiatry Report
Issue Links: Learning Objectives | Editorial Information | PDF of Issue
Adam Strassberg, MD. Dr. Strassberg has disclosed that he has no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Review of: Orlova Y, JAMA Neurology 2018;E1–E7

In 2006, the FDA issued a warning that patients using either selective serotonin reuptake inhibitors or selective norepinephrine reuptake inhibitors (SSRIs or SNRIs) together with triptan antimigraine drugs might be at a heightened risk for serotonin syndrome. Their advisory was based on 27 case reports of suspected serotonin syndrome in people who were prescribed a triptan along with one of these serotonergic antidepressants.

Because migraines are a common comorbidity in depressive and anxiety disorders, many of our patients are co-prescribed these medications. But what is the true risk for serotonin syndrome for these patients?

Yulia Orlova at the University of Florida and colleagues from Boston’s Brigham and Women’s Hospital completed a population-based study to evaluate this risk. They used electronic health records from over 6 million members in the Partners Research Data Registry to identify a cohort of 19,017 patients, who were prescribed both triptans and an SSRI or SNRI between 2001 and 2017, a total of 30,928 person-years of exposure.

Serotonin syndrome was suspected in 17 patients, and concurrent use of triptans and SSRI/SNRI was confirmed in 7 of these. Serotonin syndrome was considered definite in 2 of those cases and possible in the other 5, yielding an incidence rate of 0.6–2.3 cases per 10,000 person-years of exposure.

The rate of co-prescription did not change after the 2006 FDA warning. Between 2001 and 2014, 21%–29% of triptan users were also prescribed an SSRI or SNRI.

TCPR’s Take
Serotonin syndrome is hypothesized to involve activation of only serotonin 2A and 1A receptors. Triptans are primarily agonists for serotonin 1B and 1D receptors and do not activate serotonin 2A or 1A receptors. Thus, we doubt that triptans would increase the risk of serotonin syndrome.

This study supports that conclusion. The risk of serotonin syndrome with concomitant use of triptans and SSRIs or SNRIs appears to be very low. These results cast serious doubt on the validity of the 2006 FDA advisory and suggest that it should be reconsidered.
General Psychiatry
KEYWORDS depressive_disorder research-update
Adam Strassberg, MD.

Can Mindfulness-Based Stress Reduction Affect Symptom Outcomes in Older Adults?

More from this author
www.thecarlatreport.com
Issue Date: September 1, 2018
SUBSCRIBE NOW
Table Of Contents
CME Post-Test - Emergency Psychiatry, TCPR, September 2018
Ask the Editor
Serotonin Syndrome Risks With Co-Prescription of Triptan Drugs and SSRIs or SNRIs
Mindfulness Therapy for Adult ADHD
Benzodiazepines: New Risks for an Old Drug
Calming Agitated Patients in an Emergency
The 10 Commandments for Verbal De-Escalation
DOWNLOAD NOW
Featured Book
  • MFB6eCover.jpg

    Medication Fact Book for Psychiatric Practice, Sixth Edition (2022)

    Guidance, clinical pearls, and bottom-line assessments covering the medications you use in your...
    READ MORE
Featured Video
  • therapist_canstockphoto9201097.jpg
    General Psychiatry

    Using SAMe In Clinical Practice with Garrett Rossi, MD

    Read More
Featured Podcast
  • canstockphoto4921771.jpg
    General Psychiatry

    Psychopharm Commandment #6: MAOIs

    MAOIs rank high in efficacy and are pretty well tolerated too, as long as you watch for two critical interactions.

    Listen now
Recommended
  • Approaches to Autism Intervention

    January 31, 2022
    canstockphoto2240982_child-bubbles_thumb.jpg
  • Currently Available Cannabis Products

    September 1, 2022
  • Interpreting Assessment Discrepancies from Multiple Sources

    October 17, 2022
    ChildAssessment.png
  • Approaches to Autism Intervention

    January 31, 2022
    canstockphoto2240982_child-bubbles_thumb.jpg
  • Currently Available Cannabis Products

    September 1, 2022
  • Interpreting Assessment Discrepancies from Multiple Sources

    October 17, 2022
    ChildAssessment.png
  • Approaches to Autism Intervention

    January 31, 2022
    canstockphoto2240982_child-bubbles_thumb.jpg
  • Currently Available Cannabis Products

    September 1, 2022
  • Interpreting Assessment Discrepancies from Multiple Sources

    October 17, 2022
    ChildAssessment.png

About

  • About Us
  • CME Center
  • FAQ
  • Contact Us

Shop Online

  • Newsletters
  • Multimedia Subscriptions
  • Books
  • eBooks
  • ABPN Self-Assessment Courses

Newsletters

  • The Carlat Psychiatry Report
  • The Carlat Child Psychiatry Report
  • The Carlat Addiction Treatment Report
  • The Carlat Hospital Psychiatry Report
  • The Carlat Geriatric Psychiatry Report

Contact

info@thecarlatreport.com

866-348-9279

PO Box 626, Newburyport MA 01950

Follow Us

Please see our Terms and Conditions, Privacy Policy, Subscription Agreement, Use of Cookies, and Hardware/Software Requirements to view our website.

© 2023 Carlat Publishing, LLC and Affiliates, All Rights Reserved.