4 Sumatriptan Interactions to Watch Out for

Sumatriptan belongs to a group of medications called triptans. It’s a first-choice medication for moderate to severe migraine attacks. It can also be used for mild attacks that don’t respond to medications like nonsteroidal anti-inflammatory drugs (NSAIDs). 

Sumatriptan comes in multiple forms. This includes an oral tablet (Imitrex) and an injection (Imitrex Statdose, Zembrace SymTouch, Imitrex). It also comes as a nasal spray (Tosmyra, Imitrex) and nasal powder (Onzetra Xsail). But like all medications, it comes with some risks. This includes drug interactions with other medications. Below we’ll discuss several interactions to consider if you’re taking sumatriptan.

But keep in mind this isn’t a complete list. Always check with your healthcare provider and pharmacist before taking sumatriptan. Give them an updated list of all your medications. This will help them to check for possible sumatriptan interactions. 

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1. Monoamine oxidase inhibitors

Monoamine oxidase inhibitors (MAOIs) treat various medical conditions. Examples include depression and Parkinson’s disease. But they have many side effects and possible drug interactions. They also require certain dietary restrictions while taking them. Examples of MAOIs include selegiline (Zelapar, Emsam) and methylene blue.

Monoamine oxidase is an enzyme (protein) that’s naturally present in the body. It metabolizes (breaks down) different chemicals in the brain. It also metabolizes sumatriptan. 

MAOIs can interact with sumatriptan. This is because MAOIs prevent monoamine oxidase from working as it normally would. When monoamine oxidase is less active, sumatriptan levels can build up in the body. 

Higher sumatriptan levels make it more likely to have side effects. This could include tingling sensations, chest pain or pressure, and fatigue. It could also include more serious side effects. These include heart rhythm changes, seizures, or stroke.

Sumatriptan (and other triptans) shouldn’t be taken with MAOIs. If you’re taking an MAOI, you should stop taking it at least 2 weeks before starting sumatriptan. If stopping your MAOI isn't an option, talk to your healthcare provider. They may recommend a different migraine medication.

2. Medications that raise serotonin levels

Serotonin is a chemical in your brain. It helps regulate many body functions. This includes managing your emotions, memory, and sleep. Many medications raise serotonin levels, including sumatriptan. 

Serotonin syndrome is a rare but serious condition of too much serotonin in the brain. It’s caused by medications that increase serotonin levels. It’s unlikely to happen if you’re taking only one medication that affects serotonin at a usual dose. Most cases of serotonin syndrome happen when people take large doses of multiple medications that increase serotonin levels. Examples of medications that increase serotonin include:

• MAOIs

• Selective serotonin reuptake inhibitors (SSRIs) like citalopram (Celexa)

• Serotonin and norepinephrine reuptake inhibitors (SNRIs) like venlafaxine (Effexor XR)

• Tricyclic antidepressants (TCAs) like amitriptyline

• Tramadol (Ultram, ConZip)

• Linezolid (Zyvox)

• St. John’s wort (an herbal supplement)

Serotonin syndrome is usually mild. Mild symptoms of serotonin syndrome include sweating, faster heartbeat, and tremors. If you experience any of these symptoms, talk to your healthcare provider. They may tell you to stop taking medications that increase serotonin. But don’t do this without talking to your provider first. Some of these medications shouldn’t be stopped abruptly.

Unfortunately, symptoms can be more serious, too. Examples include a high fever, dangerously high blood pressure, and uncontrollable body movements. You should seek immediate medical care if you have any of these symptoms.

If you take one of the medications mentioned above, talk to your healthcare provider before starting sumatriptan. They may just recommend watching for signs of serotonin syndrome while taking sumatriptan. Or they may recommend another migraine medication. 

3. Ergot derivatives

Ergot derivatives are a broad group of medications that treat many medical conditions. This includes migraines, Parkinson’s disease, and hyperprolactinemia.  Examples of ergot derivatives include dihydroergotamine (Migranal, Trudhesa) and ergotamine (Ergomar).

Ergot derivatives affect multiple hormones and chemicals in the body. One effect of many ergot derivatives is the tightening of blood vessels. This is called vasoconstriction, and it can increase your blood pressure. 

Sumatriptan can also cause vasoconstriction and high blood pressure. The risk is greater if sumatriptan is combined with ergot derivatives. In serious cases, excessive vasoconstriction could potentially lead to a heart attack or stroke.

Avoid taking sumatriptan (or any triptan) within 24 hours of ergot medications. If you have any questions about this risky combination, talk to your healthcare provider. They can talk to you about why this combination isn’t a good idea, and how to best manage your migraines.

4. Other triptan medications

Sumatriptan and other triptans treat migraines by tightening blood vessels in the brain. They also block pain signals in the brain. Examples besides sumatriptan include rizatriptan (Maxalt, Maxalt-MLT) and zolmitriptan (Zomig, Zomig-ZMT).

The risk of combining other triptans with sumatriptan is similar to ergot derivatives. It could cause very high blood pressure, a heart attack, or a stroke.

You shouldn’t combine sumatriptan with other triptans. If you’re switching from one triptan to another, wait 24 hours before starting the new triptan. If you need pain relief in the meantime, talk to your healthcare provider. They may recommend NSAIDs or acetaminophen (Tylenol).

It’s important to mention that it is possible to combine different forms of the same medication. For example, your healthcare provider may recommend sumatriptan nasal spray and tablets in some cases (taken at least 1 hour apart).

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Written by:

Austin Ulrich, PharmD, BCACP

Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. In his early career, he provided direct patient care in a variety of settings, including hospital and community pharmacies, and in a primary care clinic as a clinical pharmacist.

Edited by:

Amy B. Gragnolati, PharmD, BCPS

Amy Gragnolati, PharmD, BCPS, is a pharmacy editor for GoodRx. Amy currently holds her pharmacist license in Georgia and California.

Reviewed by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

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