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Triptans: Why can't you take


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#1 Sunshine

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Posted 27 March 2006 - 10:17 PM

It's okay to take two doses of the same triptan w/in 24 hours, but everything I read says you can't take single doses of two different triptans w/in 24 hours. But I've searched high and low for a reason and can't find one.

Here's my deal:

Imitrex always, always, always works for me. But I get serious, long-lasting (2+ weeks) heart palpitations. I've had mixed results with Relpax and Midrin. My doctor recently gave me samples of Maxalt and Axert.

What I want to be able to do is take a single dose of Relpax (because it sometimes does work) or Maxalt or Axert, and if it doesn't work, then take a single dose of Imitrex. Everyone and everything says you can't do this, but no one seems to be able to explain why. I don't think there is any reason other than the PI sheets say not to take them together because they don't want people accidentally overdosing. But as long as I'm not taking two doses at the same time or more than two doses total in a 24 hr period, I don't understand the problem.

I'm looking for specific medical literature that supports or debunks this practice.

Edited by Sunshine, 27 March 2006 - 10:24 PM.

Diagnonsenses: Major Depressive Disorder (recurrent, in remission), ADD (inattentive type), Chronic Insomnia, Migraines, mild Anxiety Disorder (NOS), and a broken heart (also in remission!).
Current Cocktail (as of 11/17/2011):
~Morning: 20 mg Adderall XR, 3 mg Intuniv, and 1 mg Xanax XR
~Bedtime: 8 mg Rozerem, 5-10 mg Ambien, 200 mg Danazol (for PMDD and migraine), 100 mg Aldactone
~PRN: 2.5 mg Amerge (for migraines) and .25 mg IR Xanax
Previous meds: See profile.


#2 Velvet Elvis

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Posted 27 March 2006 - 10:19 PM

Um.  I'm pretty sure it can be potentualy fatal.  I don't remeber why but pease don't try it.

De-gnosis: ADD, recurrent depression (or maybe bpII in the guise of such), Asperger's, OCD, social anxiety
Today's Pill Menu: Dexedrine, Wellbutrin (Budeprion), Strattera, Celexa, Risperdal, and clonazepam

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#3 Sunshine

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Posted 27 March 2006 - 10:37 PM

Um.  I'm pretty sure it can be potentualy fatal.  I don't remeber why but pease don't try it.

<{POST_SNAPBACK}>

Well, that's the thing... I have tried it. And nothing bad happened. Then I found out you aren't supposed to do it.

But I don't really understand why it could be potentially fatal. Sure... if I took a dose of Imitrex AND a dose of Relpax at the same time and then repeated both meds two hours later. I get why that could potentially kill me - it's the equivalent of taking four doses of either med.

Anyway... I was hoping to find something definitive one way or the other that also explained the reasoning. I think I'm going to ask my pdoc to research it. I like my GP, but her answer was about as definitive as yours. Pdoc should know a neurologist or pharmaceutical geek who should know (my pharmacist agrees with me, by the way, at least in theory). I wanna see the data, damn it!
Diagnonsenses: Major Depressive Disorder (recurrent, in remission), ADD (inattentive type), Chronic Insomnia, Migraines, mild Anxiety Disorder (NOS), and a broken heart (also in remission!).
Current Cocktail (as of 11/17/2011):
~Morning: 20 mg Adderall XR, 3 mg Intuniv, and 1 mg Xanax XR
~Bedtime: 8 mg Rozerem, 5-10 mg Ambien, 200 mg Danazol (for PMDD and migraine), 100 mg Aldactone
~PRN: 2.5 mg Amerge (for migraines) and .25 mg IR Xanax
Previous meds: See profile.

#4 celestia

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Posted 27 March 2006 - 10:47 PM

Um.  I'm pretty sure it can be potentualy fatal.  I don't remeber why but pease don't try it.

<{POST_SNAPBACK}>

gulp!  I do it frequently...never heard this...


diagnoses: MDD/ADD/PTSD
Current meds: Wellbutrin 450/Lexapro 30



#5 AirMarshall

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Posted 28 March 2006 - 02:11 AM

Sunshine,
Here are the proposed mechanisms for drug interactions with other anti-migraine drugs which are behind the 24 hour dosing separation.   The bad outcomes include heart attacks, stroke, and seizures.

A.M.

[edit]  I realized I hadn't fully answered your specific question.  I am not going to stay up all night researching every triptan drug.  But, it appears that they hit various multiple 5hT receptors (some of which are not fully known) and thus I would guess that you run the risk of overdosing or saturating one or more receptor.

A comparson would be maxing out on one opiod (say oxycodone) then switching to hydrocodone and wondering why your respiration stopped. Yes you didn't exceed either max dosage, but they use similar pathways and have similar overdose effects. Again, this is just an illustrative example.

Hope your headaches are fewer.  A.M.


  From www.rxlist.com:

DRUG INTERACTIONS

Ergot-containing drugs have been reported to cause prolonged vasospastic reactions. Because there is a theoretical basis that these effects may be additive, use of ergotamine-containing or ergot-type medications (like dihydroergotamine or methysergide) and sumatriptan within 24 hours of each other should be avoided (see CONTRAINDICATIONS).

MAO-A inhibitors reduce sumatriptan clearance, significantly increasing systemic exposure. Therefore, the use of sumatriptan succinate tablets in patients receiving MAO-A inhibitors is contraindicated (see CLINICAL PHARMACOLOGY and CONTRAINDICATIONS).

Selective serotonin reuptake inhibitors (SSRIs) (e.g., fluoxetine, fluvoxamine, paroxetine, sertraline) have been reported, rarely, to cause weakness, hyperreflexia, and incoordination when coadministered with sumatriptan. If concomitant treatment with sumatriptan and an SSRI is clinically warranted, appropriate observation of the patient is advised.


Edited by AirMarshall, 28 March 2006 - 02:29 AM.

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#6 Velvet Elvis

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Posted 28 March 2006 - 07:06 PM

Here's a discussion in another forum.  I can make no claims as to the veracity of the information contained therein.

http://www.migrainep...orum=discussion

De-gnosis: ADD, recurrent depression (or maybe bpII in the guise of such), Asperger's, OCD, social anxiety
Today's Pill Menu: Dexedrine, Wellbutrin (Budeprion), Strattera, Celexa, Risperdal, and clonazepam

Like other moderators and staff of crazyboards.org, I am not a health care professional. You have no way of knowing that I am not talking out my ass. Please do your own homework before making any health related decisions.

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#7 ncc1701

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Posted 28 March 2006 - 10:15 PM

Heya Sunshine,

At this point I would ask a specialist.

There are likely good pharmacological reasons not to mix triptans.

No interactions showed up when I ran a quick search on Medscape.com.

But on ePocrates.com, I found this:

"contraindicated within 24h of use: combo may incr. risk of severe, prolonged vasospasm, adverse effects (additive effects)"

I can't tell you much about the pharmacology without doing a lot more research.  Medscape.com is a good start b/c for free registration, you can access Medline and drug references.

What about a headache clinic or pain clinic?

In TO (sorry hon the only city I really know) there's Toronto Western Krembil Neurosciences Centre:

http://www.uhn.ca/pr...ms/nss/pain.asp

There are quite a few neurologists who deal with pain/migraine as a special interest.

By all means ask your psych or FP about a referral!

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#8 Sunshine

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Posted 28 March 2006 - 11:50 PM

Thanks everyone (especially ncc - I was hoping you'd make a guest appearance!). The forum VE referred me to was basically having the same discussion and several members reported that they mix triptans under their doctor's care/advice (in the manner I described earlier).

Definitely going to ask the pdoc to look into it for me. He doesn't treat my migraines, but he's good at research, seems to have a strong pharmaceutical aptitude, will know the right people to ask, and I think will do it for me if I ask.
Diagnonsenses: Major Depressive Disorder (recurrent, in remission), ADD (inattentive type), Chronic Insomnia, Migraines, mild Anxiety Disorder (NOS), and a broken heart (also in remission!).
Current Cocktail (as of 11/17/2011):
~Morning: 20 mg Adderall XR, 3 mg Intuniv, and 1 mg Xanax XR
~Bedtime: 8 mg Rozerem, 5-10 mg Ambien, 200 mg Danazol (for PMDD and migraine), 100 mg Aldactone
~PRN: 2.5 mg Amerge (for migraines) and .25 mg IR Xanax
Previous meds: See profile.

#9 Guest_Guest_winterishere_*_*

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Posted 11 November 2007 - 11:24 PM

It's okay to take two doses of the same triptan w/in 24 hours, but everything I read says you can't take single doses of two different triptans w/in 24 hours. But I've searched high and low for a reason and can't find one.

Here's my deal:

Imitrex always, always, always works for me. But I get serious, long-lasting (2+ weeks) heart palpitations. I've had mixed results with Relpax and Midrin. My doctor recently gave me samples of Maxalt and Axert.

What I want to be able to do is take a single dose of Relpax (because it sometimes does work) or Maxalt or Axert, and if it doesn't work, then take a single dose of Imitrex. Everyone and everything says you can't do this, but no one seems to be able to explain why. I don't think there is any reason other than the PI sheets say not to take them together because they don't want people accidentally overdosing. But as long as I'm not taking two doses at the same time or more than two doses total in a 24 hr period, I don't understand the problem.

I'm looking for specific medical literature that supports or debunks this practice.


Serotonin Syndrome

#10 Sunshine

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Posted 12 November 2007 - 07:27 PM

Serotonin Syndrome

If that were the case, you couldn't take two doses of the same triptan within 24 hours (which you can). In other words, I can take a single dose of Amerge and then a second dose two hours later. But I allegedly can't take a single dose of Amerge and then a single dose of Imitrex two hours later. I can't see any medical reason why this is the case... other than it might be confusing to explain to the average patient. And probably because they haven't done any official studies on it.
Diagnonsenses: Major Depressive Disorder (recurrent, in remission), ADD (inattentive type), Chronic Insomnia, Migraines, mild Anxiety Disorder (NOS), and a broken heart (also in remission!).
Current Cocktail (as of 11/17/2011):
~Morning: 20 mg Adderall XR, 3 mg Intuniv, and 1 mg Xanax XR
~Bedtime: 8 mg Rozerem, 5-10 mg Ambien, 200 mg Danazol (for PMDD and migraine), 100 mg Aldactone
~PRN: 2.5 mg Amerge (for migraines) and .25 mg IR Xanax
Previous meds: See profile.

#11 AirMarshall

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Posted 12 November 2007 - 09:23 PM

Serotonin Syndrome


No! Because the tripan drugs don't work thru the serotonin receptors. See my post above about the 5hT receptors.

BTW this thread is 1.5 years old.

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#12 Sunshine

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Posted 13 November 2007 - 09:46 PM

BTW this thread is 1.5 years old.

I'm still looking for a good answer.

The info you posted earlier partially explains it, but I'm not talking about maxing out on the dose of one and then switching to another. For example, you can take up to 200 mg of Imitrex in a 24 hr period - usually in 100 mg doses. You can also take up to 5 mg of Amerge in a 24 hr period - usually in doses of 2.5 mg each. I'm proposing to take 2.5 mg of Amerge and then 100 mg of Imitrex a few hours later if necessary.
Diagnonsenses: Major Depressive Disorder (recurrent, in remission), ADD (inattentive type), Chronic Insomnia, Migraines, mild Anxiety Disorder (NOS), and a broken heart (also in remission!).
Current Cocktail (as of 11/17/2011):
~Morning: 20 mg Adderall XR, 3 mg Intuniv, and 1 mg Xanax XR
~Bedtime: 8 mg Rozerem, 5-10 mg Ambien, 200 mg Danazol (for PMDD and migraine), 100 mg Aldactone
~PRN: 2.5 mg Amerge (for migraines) and .25 mg IR Xanax
Previous meds: See profile.

#13 goldenbvtterfly

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Posted 19 February 2008 - 03:25 AM

Serotonin Syndrome


No! Because the tripan drugs don't work thru the serotonin receptors. See my post above about the 5hT receptors.

BTW this thread is 1.5 years old.


5ht stands for 5-hydroxytryptamine, it is the same thing as Serotonin. The terms are used interchangeably.

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