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Zembrace SymTouch (sumatriptan) Disease Interactions

There are 4 disease interactions with Zembrace SymTouch (sumatriptan):

Major

5-Ht1 Agonists (Includes Zembrace SymTouch) ↔ Cad Risk Factors

Severe Potential Hazard, High plausibility

Applies to: Diabetes Mellitus, History (Familial) - Ischemic Heart Disease, Hyperlipidemia, Menopausal Disorders, Obesity, Smoking

The group of drugs known as 5-hydroxytryptamine1 receptor (5-HT1) agonists can cause vasospastic reactions, including coronary vasospasm, peripheral vascular ischemia, and colonic ischemia. Rarely, serious adverse cardiac events including acute myocardial infarction, arrhythmia, cardiac arrest, and death have been reported within a few hours following the administration of 5-HT1 agonists, in some cases even in patients with no prior history or findings of coronary artery disease (CAD). Significant elevation in blood pressure, including hypertensive crisis, has also been reported on rare occasions in patients with and without a history of hypertension, as have transient increases in blood pressure and peripheral vascular resistance. In general, patients with potentially unrecognized CAD as predicted by the presence of risk factors (e.g., hypertension, hypercholesterolemia, tobacco use, obesity, diabetes, strong family history of CAD, female with surgical or physiological menopause, or male over 40 years of age) should not be administered 5-HT1 agonists unless a cardiovascular evaluation provides satisfactory clinical evidence indicating the lack of CAD, ischemic heart disease, or other significant underlying cardiovascular disease. As a precaution, the manufacturers recommend that the first dose be administered under medical surveillance in such patients, and that electrocardiographic monitoring be considered during the interval immediately following administration to help detect any asymptomatic cardiac ischemia that may occur. Periodic cardiovascular evaluations should be performed during intermittent, long-term use.

References

  1. Mueller L, Gallagher RM, Ciervo CA "Vasospasm-induced myocardial infarction with sumatriptan." Headache 36 (1996): 329-31
  2. Kelly KM "Cardiac arrest following use of sumatriptan." Neurology 45 (1995): 1211-3
  3. "Product Information. Axert (almotriptan)" Pharmacia and Upjohn, Kalamazoo, MI.
View all 23 references
Major

5-Ht1 Agonists (Includes Zembrace SymTouch) ↔ Cardiovascular Disease

Severe Potential Hazard, High plausibility

Applies to: History - Myocardial Infarction, Cardiovascular Disease, Cerebral Vascular Disorder, History - Cerebrovascular Disease

The use of 5-hydroxytryptamine1 receptor (5-HT1) agonists is contraindicated in patients with a current or past history of ischemic cardiac, cerebrovascular, and/or peripheral vascular diseases. In addition, these agents should not be used in patients with significant underlying cardiovascular diseases or uncontrolled hypertension. 5-HT1 agonists can cause vasospastic reactions, including coronary vasospasm, peripheral vascular ischemia, and colonic ischemia. Rarely, serious adverse cardiac events including acute myocardial infarction, arrhythmia, cardiac arrest, and death have been reported within a few hours following the administration of 5-HT1 agonists, in some cases even in patients with no prior history or findings of coronary artery disease (CAD). Significant elevation in blood pressure, including hypertensive crisis, has also been reported on rare occasions in patients with and without a history of hypertension, as have transient increases in blood pressure and peripheral vascular resistance. Cerebrovascular events have included cerebral hemorrhage, subarachnoid hemorrhage, and stroke, some resulting in fatalities. However, the relationship to 5-HT1 agonists is uncertain and, in a number of cases, the cerebrovascular events may have been primary where symptoms were mistaken to be migraine.

References

  1. Ottervanger JP, Paalman HJ, Boxma GL, Stricker BH "Transmural myocardial infarction with sumatriptan." Lancet 341 (1993): 861-2
  2. Kelly KM "Cardiac arrest following use of sumatriptan." Neurology 45 (1995): 1211-3
  3. "Product Information. Axert (almotriptan)" Pharmacia and Upjohn, Kalamazoo, MI.
View all 23 references
Major

Sumatriptan (Includes Zembrace SymTouch) ↔ Liver Disease

Severe Potential Hazard, High plausibility

Applies to: Liver Disease

The manufacturer considers the use of sumatriptan to be contraindicated in patients with severe hepatic impairment. Sumatriptan is primarily metabolized by the liver. Following subcutaneous administration, the pharmacokinetics of sumatriptan were not significantly altered in patients with hepatic impairment compared to healthy controls. Following oral administration, however, the bioavailability was substantially increased compared to controls, presumably because the liver plays an important role in the presystemic clearance of orally administered sumatriptan. The maximum single oral dose should generally not exceed 50 mg in patients with impaired hepatic function. Data are not available for the nasal formulation.

References

  1. "Product Information. Imitrex (sumatriptan)." Glaxo Wellcome, Research Triangle Park, NC.
  2. Dixon CM, Saynor DA, Andrew PD, Oxford J, Bradbury A, Tarbit MH "Disposition of sumatriptan in laboratory animals and humans." Drug Metab Dispos 21 (1993): 761-9
  3. Fowler PA, Lacey LF, Thomas M, Keene ON, Tanner RJ, Baber NS "The clinical pharmacology, pharmacokinetics and metabolism of sumatriptan." Eur Neurol 31 (1991): 291-4
View all 4 references
Moderate

Sumatriptan (Includes Zembrace SymTouch) ↔ Seizure Disorders

Moderate Potential Hazard, Moderate plausibility

Applies to: Seizures

Seizures have rarely been reported following the administration of sumatriptan. Therapy with sumatriptan should be administered cautiously in patients with epilepsy or a history of seizures.

References

  1. "Product Information. Imitrex (sumatriptan)." Glaxo Wellcome, Research Triangle Park, NC.

Zembrace SymTouch (sumatriptan) drug Interactions

There are 59 drug interactions with Zembrace SymTouch (sumatriptan)

Zembrace SymTouch (sumatriptan) alcohol/food Interactions

There are 2 alcohol/food interactions with Zembrace SymTouch (sumatriptan)

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.

Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.

Do not stop taking any medications without consulting your healthcare provider.

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