Ischemic colitis related to sumatriptan overuse.
BACKGROUND
Serotonin-1 5-hydroxytryptamine (5-HT 1) receptor agonists are first line agents for migraine headaches. Patients with refractory headaches may use supratherapeutic doses of these medications. Described is a case of ischemic colitis related to overuse of sumatriptan.


METHODS
A 35-year-old woman presented with severe abdominal pain without diarrhea or hematochezia. For several days prior she had been self-treating a refractory migraine headache with frequent doses of sumatriptan. She is a nonsmoker and took no oral contraceptives or other serotonin agonists. A computed tomography scan of the abdomen revealed left-sided colitis. A colonoscopy with biopsy confirmed ischemic colitis and excluded inflammatory bowel disease (IBD).


CONCLUSIONS
Previously published case reports have suggested an association between 5-HT 1 receptor agonists and ischemic colitis. These reports have been dismissed because the patients were taking oral contraceptives, serotonin agonists, or had other comorbidities. This healthy patient lacked risk factors for ischemia, is the youngest to be reported, and is the first without hematochezia.


CONCLUSIONS
5-HT 1 receptor agonists are generally considered safe. Ischemic colitis is a potentially serious complication of these agents. A retrospective review of 5-HT 1 receptor agonist users who have presented with acute onset abdominal pain or hematochezia is necessary to elucidate the incidence of this adverse event.
Hodge
Joshua A
JA
National Capital Consortium-Dewitt Army Community Hospital, Family Medicine Residency, Ft. Belvoir, VA, USA. joshua.hodge@amedd.army.mil
Hodge
Katherine D
KD
D000328:Adult; D017091:Colitis, Ischemic / Q000139:chemically induced* / Q000000981:diagnostic imaging; D003113:Colonoscopy; D003937:Diagnosis, Differential; D004305:Dose-Response Relationship, Drug; D062787:Drug Overdose / Q000150:complications*; D005260:Female; D006801:Humans; D008881:Migraine Disorders / Q000188:drug therapy*; D017366:Serotonin Receptor Agonists / Q000008:administration & dosage / Q000633:toxicity*; D018170:Sumatriptan / Q000008:administration & dosage / Q000633:toxicity*; D014057:Tomography, X-Ray Computed; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000633:toxicity*
D017366:Serotonin Receptor Agonists; D014662:Vasoconstrictor Agents; D018170:Sumatriptan