Editing Triptan (section)

==Interactions==
Combination of triptans with other serotonergic drugs such as ergot alkaloids, monoamine oxidase inhibitors, [[selective serotonin reuptake inhibitor]]s (SSRIs), [[serotonin–norepinephrine reuptake inhibitor]]s (SNRIs) or [[St John's wort]] has been alleged to induce symptoms of a [[serotonin syndrome]] (a syndrome of changes in mental status, autonomic instability, neuromuscular abnormalities, and gastrointestinal symptoms),<ref name="Mutschler" /><ref name="AC" /> whereas scientific studies indicate there is no potential for life-threatening serotonin syndrome in patients taking triptans and SSRI or SNRIs at the same time, although the FDA has officially stated otherwise.<ref name="Rolan 2012 pp. 949–957">{{cite journal | last=Rolan | first=Paul E. | title=Drug Interactions with Triptans | journal=CNS Drugs | publisher=Springer Science and Business Media LLC | volume=26 | issue=11 | date=2012-09-25 | issn=1172-7047 | pmid=23018546 | doi=10.1007/s40263-012-0002-5 | pages=949–957| s2cid=43699741 }}</ref><ref>{{cite journal|title=The Serotonin Syndrome, Triptans, and the Potential for Drug–Drug Interactions|journal=Headache: The Journal of Head and Face Pain|volume=47|issue=2|pages=266–9|doi=10.1111/j.1526-4610.2006.00691.x|pmid=17300366|year=2007|last1=Shapiro|first1=Robert E.|last2=Tepper|first2=Stewart J.|s2cid=21075435}}</ref><ref>{{cite journal|title=The FDA Alert on Serotonin Syndrome With Use of Triptans Combined With Selective Serotonin Reuptake Inhibitors or Selective Serotonin-Norepinephrine Reuptake Inhibitors: American Headache Society Position Paper|journal=Headache: The Journal of Head and Face Pain|volume=50|issue=6|pages=1089–99|doi=10.1111/j.1526-4610.2010.01691.x|pmid=20618823|year=2010|last1=Evans|first1=Randolph W.|last2=Tepper|first2=Stewart J.|last3=Shapiro|first3=Robert E.|last4=Sun-Edelstein|first4=Christina|last5=Tietjen|first5=Gretchen E.|s2cid=40713435|doi-access=free}}</ref><ref>{{cite journal|title=Triptans, serotonin agonists, and serotonin syndrome (serotonin toxicity): a review|last1=Gillman|journal=Headache|volume=50|issue=2|year=2010|pages=264–272|doi=10.1111/j.1526-4610.2009.01575.x|pmid=19925619|s2cid=221752556 |doi-access=free}}</ref><ref>{{cite journal|title=The FDA alert on serotonin syndrome with combined use of SSRIs or SNRIs and triptans: an analysis of the 29 case reports|    journal=MedGenMed|    volume=9|    issue=3|    page=48|    pmid=18092054|    pmc=2100123|    year=2007|    last1=Evans|    first1=R. W.}}</ref><ref>{{cite journal|title=Serotonin syndrome risks when combining SSRI/SNRI drugs and triptans: is the FDA's alert warranted?|journal=Annals of Pharmacotherapy|volume=42|issue=11|pages=1692–6|pmid=18957623|year=2008|last1=Wenzel|first1=R. G.|last2=Tepper|first2=S|last3=Korab|first3=W. E.|last4=Freitag|first4=F|doi=10.1345/aph.1L260|s2cid=24942783}}</ref><ref name="FDA ALERT [7/2006]:">{{cite web|url=https://www.fda.gov/CDER/Drug/InfoSheets/HCP/venlafaxineHCP.htm|title=Information for Healthcare Professionals|last=US Food and Drug Administration|date=2006-07-19|publisher=[[Food and Drug Administration]]|access-date=2008-01-10|archive-url=https://web.archive.org/web/20080219184710/https://www.fda.gov/CDER/Drug/InfoSheets/HCP/venlafaxineHCP.htm <!-- Bot retrieved archive -->|archive-date=2008-02-19}}</ref> Combining triptans with ergot alkaloids is contraindicated because of the danger of coronary spasms.<ref name="AC" />

In a study from [[Harvard Medical School]] and the [[University of Florida College of Medicine]] involving 47,968 patients and published on 26 February 2018, concomitant use of a [[selective serotonin reuptake inhibitor]] or [[selective norepinephrine reuptake inhibitor]] for [[Major depressive disorder|depression]] with a triptan for [[migraine]] did not demonstrate an increased risk of the [[serotonin syndrome]].<ref>{{cite journal|title=Association of Coprescription of Triptan Antimigraine Drugs and Selective Serotonin Reuptake Inhibitor or Selective Norepinephrine Reuptake Inhibitor Antidepressants With Serotonin Syndrome |first1=Yulia|last1=Orlova|first2=Paul|last2=Rizzoli|first3=Elizabeth|last3=Loder|date=26 February 2018|journal=JAMA Neurology|volume=75|issue=5|pages=566–572|pmid=29482205|doi=10.1001/jamaneurol.2017.5144|pmc=5885255}}</ref>

[[Pharmacokinetic]] interactions (for example, mediated by [[cytochrome P450|CYP]] liver enzymes or [[transporter protein]]s) are different for the individual substances; for most triptans, they are mild to absent. Eletriptan blood plasma levels are increased by strong inhibitors of [[CYP3A4]], and frovatriptan levels by [[CYP1A2]] inhibitors such as [[fluvoxamine]].<ref name="AC" />