Reactions 1486, p26-27 - 1 Feb 2014

SSumatriptan

Cardiac disorders: case reportA 53-year-old woman developed cardiac disorders after

receiving sumatriptan for migraine.The woman had a history of migraine treated with SC

sumatriptan 6mg injection or sumatriptan 100mg tablet [routenot stated] with good response. She subsequently escalatedher sumatriptan to ten or more doses per month due to morefrequent headaches. In 2006, she experienced an exacerbationof migraine and reported using up to eight sumatriptan doses[dose not stated] in 1 month. She also described chest painoccurring after an oral sumatriptan 100mg dose. An EKGperformed at the time showed non-specific ST and T wavechanges with normal intervals.

The woman was switched to almotriptan, but this alsoinduced mild retrosternal chest pain and tightness. Shereturned to using oral sumatriptan 50–100mg at migraineonset. On 15 November 2007, she developed chest pain,bilateral arm pain and diaphoresis within 10 minutes of takingoral sumatriptan 50mg. An EKG tracing in the ambulanceshowed a correct QT(c) interval of 423ms. Her chest painresolved with oxygen. A self-limited episode of polymorphicventricular tachycardia occurred en route. On arrival at thecardiac care unit, her QTc interval was measured at 501ms;prolonged QT interval tracings persisted for the next 2 days.She was placed with a intracardiac defibrillator prior todischarge. After returning home, she was evaluated again bycardiology, with a QTc interval of 419ms. Cardiaccatheterisation revealed mild diffuse atherosclerosis proximalto the mid left anterior descending artery. Angiographyshowed coronary vasospasm in the left anterior descendingartery around the plaque area. This responded tonitroglycerine. The final diagnosis was vasospastic angina. Shewas subsequently maintained on topiramate, nifedipine andnitroglycerine, as needed, and has done well.

Author comment: "We also report an illustrative case ofpolymorphic ventricular tachyarrhythmia/Torsade de Pointes(TdP), electrocardiogram (EKG) changes consistent withcardiac ischemia, and acquired QTc interval lengtheningfollowing oral sumatriptan in a 53-year-old migraineurwithout risk factors for [coronary artery disease]".Stillman MJ, et al. QT prolongation, Torsade de Pointes, myocardial ischemia fromcoronary vasospasm, and headache medications. Part 1: review of serotonergiccardiac adverse events with a triptan case. Headache 53: 208-16, No. 1, Jan 2013 -USA 803098767

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Reactions 1 Feb 2014 No. 14860114-9954/14/1486-0001/$14.95 Adis © 2014 Springer International Publishing AG. All rights reserved