Your patient has CAD and migraine and is taking Paxil for depression. Can he take a triptan?
The FDA has placed a warning on the label for Imitrex in patients with CAD, because triptans cause vasoconstriction and can increase the risk of cardiac ischemia. Likewise, Cafergot and other ergots can cause vasoconstriction and are contraindicated in CAD. The FDA also advises that triptans like Axert should not be co-prescribed with SSRIs like Paxil, or with SNRIs, due to the risk of life-threatening serotonin syndrome. Excedrin Migraine does not carry a warning for patients with CAD or depression.
While combined hormonal contraceptives are contraindicated in migraine with aura due to the risk of ischemic stroke, they are not contraindicated in migraine without aura according to a 2016 CDC update on medical eligibility for contraceptive use. In 2010, the American College of Obstetricians and Gynecologists noted that hormonal contraceptives may improve migraine control by addressing the decrease in estrogen levels that may precipitate migraines.
A. Suicidal behavior
In addition to epilepsy, Topamax (topiramate) is indicated for migraine prophylaxis. FDA warnings for Topamax include suicidal ideation and behavior. Cafergot carries a warning for peripheral ischemia. Metformin carries a warning for lactic acidosis. Excedrin migraine carries a warning for Reyes syndrome.