Does Anyone Take SSRIs with Triptans?

[vacillate_wildly]

Sorry so long. I'm just really frustrated here

 

So, I have migraines and I've been prescribed Imitrex for about a year and a half now. I am also on Prozac. I don't think I was on Prozac at the time I was originally prescribed the Imitrex. I've been on Prozac in the past, though it was before I was ever really diagnosed with migraines. So, I'm Bipolar-I and I've been having a really hard time coming out of a recent depressive episode. I told my pdoc that Prozac has helped me before, and while she was originally hesitant, she finally gave me some, first 10mg and now up to 20mg.

 

The other day, the pharmacist asked me if I was taking the Imitrex and the Prozac and I said yes and he told me not to, that it can cause seizures and serotonin syndrome. Well, I am shocked and dismayed. I had no idea, and I've been taking them both. I looked it up, and sure enough, Triptans (such as Imitrex) act on serotonin in the brain, so taking SSRIs with them can basically poison you with serotonin. I'm already on anticonvulsants (Lamictal and Trileptal), for my Bipolar that I are also sometimes used for prevention of migraines. I have a little less migraines, but I still get them. 

So, I need to call my neurologist and see if there's anything else that can help me.

 

Has anyone here actually taken Triptans with SSRis, or am I really basically shit out of luck on this one? I certainly don't want to get serotonin syndrome. But I tried looking up what else can help me with my migraines and I didn't find too much, aside from something called Midrin. I also saw that beta blockers or calcium channel blockers "might" be preventative. I often take store brand Aleve to try and help my migraines before they get worse, but it doesn't usually do anything. And I don't thing plain old pain killers are going to help me with my nausea and cognitively impaired feeling. The fuzzy feeling I get is very bothersome, especially while I'm at work. Imitrex clears it right up usually, and I become functional again.

 

Also, has anyone per chance had any luck with any other migraines medications that don't act on serotonin? I feel like I'm stuck between a rock and a hard place here. Don't know if I should get rid of the Prozac and ask for Wellbutrin instead. All I know is I need both an anti depressant and something to abortively treat my migraines, as I'm already on things that slightly prevent them.

 

Again, sorry this was so long. 

 

 

[amosleigh]

I take sumatriptan and Viibryd. I only use about two  to three sumatriptans during the month and my PDOC didn't seem concerned about it.

[shesellsseashells]

Hi vacillate, I also take Prozac and Imitrex.  I have done so at various points in my life and haven't had a problem.  I take Propranolol as a migraine preventative, which helps me quite a bit.  None of my MDs or pharmacists have ever mentioned the contraindication to me, but I poked around after reading your post and found multiple sites stating that taking the two meds together may indeed increase the risk for serotonin syndrome.  I will ask my pdoc about this at my next appointment, but unless he expresses concern, I will continue to take the Imitrex now and again for migraines, since it works for me.  Thanks for bringing this up.

[Sync]

My Gdoc told me I can't ever take Imitrex while on Zoloft, because I could get serotonin syndrome. I would highly recommend asking your docs about this. I mostly manage my migraines with biofeedback/relaxation therapy now, which isn't anywhere near as effective as Imitrex, but I'll take (my luckily infrequent) migraines over being coocoo for cocoapuffs any day. 

[vacillate_wildly]

Thank you all so much for your replies, I'm definitely planning on asking both of my doctors about this. For now I think I'll do my best to avoid the Imitrex unless it's a really bad migraine. Tonight I was able to handle it by using an ice pack on my head.

[mcjimjam]

Pharmacists can sometimes be overly cautious. I've had them question combinations my pdoc has deemed to be safe and I know to be safe. Remeron + Cymbalta can potentially cause serotonin syndrome too. As can lithium + cymbalta or lithium + remeron. But I'm fine.  Definitely talk to your neuro and pdoc, but I think you may be able to take an SSRI with a triptan. 

 

FWIW, when I feel a migraine come on I take three aspirins (900mg). If I get it early, that often works for me. You can combine the aspirin with Tylenol 1000mg, to make it even more likely to work. Soluble forms are better, because they kick in faster. Where I live there are OTC antiemetics for migraine-associated nausea. Prochlorperazine or metoclopramide, IIRC. I'm guessing you've tried these types of things and they haven't worked for you. I just thought I'd mention what works for me, in case you haven't and can't take the Imitrex.

[vacillate_wildly]

Pharmacists can sometimes be overly cautious. I've had them question combinations my pdoc has deemed to be safe and I know to be safe. Remeron + Cymbalta can potentially cause serotonin syndrome too. As can lithium + cymbalta or lithium + remeron. But I'm fine.  Definitely talk to your neuro and pdoc, but I think you may be able to take an SSRI with a triptan. 

 

FWIW, when I feel a migraine come on I take three aspirins (900mg). If I get it early, that often works for me. You can combine the aspirin with Tylenol 1000mg, to make it even more likely to work. Soluble forms are better, because they kick in faster. Where I live there are OTC antiemetics for migraine-associated nausea. Prochlorperazine or metoclopramide, IIRC. I'm guessing you've tried these types of things and they haven't worked for you. I just thought I'd mention what works for me, in case you haven't and can't take the Imitrex.

Thank you for you reply as well. I haven't tried the aspirin and tylenol combo before, I'll have to try that. I don't think we sell those two items OTC where I live (USA).

[lavender fairy]

One other thing that I have done for migraine has been to drink some caffeine when I feel it coming on.  I was told this trick by a doc once, and it seems to work for me.  The trick is that you have to not be a regualr caffeine user, or your body is just to accustomed to it.  Unless you are having a caffeine withdrawl headache, in that case the caffeine would work I assume.  There are actually prescription migraine meds that have caffeine in them. 

[vacillate_wildly]

One other thing that I have done for migraine has been to drink some caffeine when I feel it coming on.  I was told this trick by a doc once, and it seems to work for me.  The trick is that you have to not be a regualr caffeine user, or your body is just to accustomed to it.  Unless you are having a caffeine withdrawl headache, in that case the caffeine would work I assume.  There are actually prescription migraine meds that have caffeine in them. 

Thanks for the tip, unfortunately I have caffeine every day, can't function without it. 

[tamagotchi]

I tried looking up what else can help me with my migraines and I didn't find too much, aside from something called Midrin.

 

I take Midrin and it helps with my migraines, it is worth a try.  In the past I had used Imitrex and Fioricet but I had more side effects with those. (Disclaimer: I am not on SSRIs and can't tolerate them anyway.)

 

Off topic but, how do you like your hydroxyzine?  I was just reminded of that in another thread 

Edited February 20, 2014 by tamagotchi

[vacillate_wildly]

 

I tried looking up what else can help me with my migraines and I didn't find too much, aside from something called Midrin.

 

I take Midrin and it helps with my migraines, it is worth a try.  In the past I had used Imitrex and Fioricet but I had more side effects with those. (Disclaimer: I am not on SSRIs and can't tolerate them anyway.)

 

Off topic but, how do you like your hydroxyzine?  I was just reminded of that in another thread 

 

Thanks, that's good to know about the Midrin! I rarely take the hydroxyzine, but it does put me to sleep if I need it. My pdoc actually said she'd take it off my list since I take it so little.

[crtclms]

For severe pain, I have Midrin, 2mg wallups of ativan (I had this approved by moth my pdoc and ndoc, do not try this at home), and I have both imitrex and migranal if I catch early. Sometimes excedrin will also work if I catch it early enough. Excedrin is caffeine, tylenol, and aspirin combined. I usually end up lying down for a few hours, though, even if they help a bit.

 

I live in the US, and all these meds, and the ones listed above (except for the ativan, imitrex and migranal), are available OTC.

 

Just so you know, if it becomes an issue, migranal is not a triptan

 

And sometime a goodly dose of ibuprofen can help with the really stiff neck headaches.

[vacillate_wildly]

For severe pain, I have Midrin, 2mg wallups of ativan (I had this approved by moth my pdoc and ndoc, do not try this at home), and I have both imitrex and migranal if I catch early. Sometimes excedrin will also work if I catch it early enough. Excedrin is caffeine, tylenol, and aspirin combined. I usually end up lying down for a few hours, though, even if they help a bit.

 

I live in the US, and all these meds, and the ones listed above (except for the ativan, imitrex and migranal), are available OTC.

 

Just so you know, if it becomes an issue, migranal is not a triptan

 

And sometime a goodly dose of ibuprofen can help with the really stiff neck headaches.

Thank you for your response, I've been using a lot tylenol and aspirin, which has helped some. I keep forgetting to call my neurologist to get an appointment. That's good to know that migranal is not a triptan. Thankfully, my migraines aren't as debilitating as the one "worst headache of your life" migraine I had when I was 15, so I don't typically need to lay down.

[IsabelleStPierre]

I've had chronic migraines for years and take Imitrex on a fairly regular basis and I also take Prozac without any problems. During all of my inpatient stays the pdoc's never seemed worried about my taking both medications. My general practitioner, neurologist, and pharmacist know I take both and no one has seemed concerned with my taking both...

 

I will definitely bring this up the next time I see my doctors, but this isn't anything I've heard about personally...

[vacillate_wildly]

I've had chronic migraines for years and take Imitrex on a fairly regular basis and I also take Prozac without any problems. During all of my inpatient stays the pdoc's never seemed worried about my taking both medications. My general practitioner, neurologist, and pharmacist know I take both and no one has seemed concerned with my taking both...

 

I will definitely bring this up the next time I see my doctors, but this isn't anything I've heard about personally...

It's good to know that you take them both without any issues, I see my pdoc next week, so I'm going to double check with her and if she says it's ok, I'm going to go back to using the Imitrex. 

[dtac]

I took imitrex one time while on prozac and had serotonin syndrome symptoms. I was on a very low dose of prozac, and the lowest dose of imitrex. You feel sick and like you're about to die. I just waited it out once I realized it wasn't getting any worse and I didn't need to go to the hospital (after running everything by a nurse.) It was one of the scariest experiences in my life. I'll never touch either of those drugs again.