Sumatriptan therapy for headache and acute myocardial infarction.
BACKGROUND
Migraine is a common, debilitating, chronic neurovascular disorder. Triptans are considered the drugs of choice to treat migraine attacks; however, their use is limited owing to concerns about cardiovascular safety.


METHODS
The aim of this review is to describe: the mechanisms of action of triptans; the case-reports of acute myocardial infarction (AMI) associated with sumatriptan use; and the results of studies evaluating its tolerability and safety.


RESULTS
Sumatriptan administration can be followed, in close temporal relationship, by AMI in young or adult migraine patients. Some of these cases have developed in subjects taking their first dose. Based on the results of prospective studies, the risk of severe cardiovascular adverse events after the use of a triptan is estimated at 1:100,000 treated attacks. These adverse events, albeit very infrequent, highlight the importance of careful adherence to the sumatriptan prescribing information.


CONCLUSIONS
Inherent in its mechanism of action, sumatriptan could produce (coronary) vasospasm sometimes followed by AMI. The drug should not be prescribed to patients with history, symptoms or signs of ischemic vascular disease; an in-depth evaluation should be carried out in subjects at intermediate cardiovascular risk.
Antonio Cardarelli Hospital, Cardiology Unit, Via Antonio Cardarelli, 9, 80131 Naples, Italy. giovanni.gaeta@tin.it
Silvia
S
Barra
Simona
S
Lanero
Alfredo
A
Madrid
Crescenzo
C
Materazzi
Giancarlo
G
Vitagliano
Paul R J
PR
Ames
Giovanni
G
Gaeta
D000293:Adolescent; D000328:Adult; D000818:Animals; D003329:Coronary Vasospasm / Q000139:chemically induced; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000188:drug therapy* / Q000503:physiopathology; D009203:Myocardial Infarction / Q000139:chemically induced*; D012307:Risk Factors; D058825:Serotonin 5-HT1 Receptor Agonists / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D018170:Sumatriptan / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D055815:Young Adult
D058825:Serotonin 5-HT1 Receptor Agonists; D018170:Sumatriptan