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Stillman, 2013 QT Prolongation, Torsade de Pointes, Myocardial Ischemia From Coronary Vasospasm, and Headache Medications....


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Antidepressants are included as drugs that may vasoconstrict coronary and cerebral arteries and cause QTc prolongation in the heart.


Headache. 2013 Jan;53(1):217-24. doi: 10.1111/j.1526-4610.2012.02299.x. Epub 2012 Dec 6.

QT Prolongation, Torsade de Pointes, Myocardial Ischemia From Coronary Vasospasm, and Headache Medications. Part 2: Review of Headache Medications, Drug-Drug Interactions, QTc Prolongation, and Other Arrhythmias.

Stillman MJ, Tepper DE, Tepper SJ, Cho L.




Headache Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.


Abstract at http://www.ncbi.nlm.nih.gov/pubmed/23216298


Serotonin (5-hydroxytryptamine)(1) (B) (/1) (D) agonists can vasoconstrict coronary and cerebral arteries. Chest, jaw, and arm discomfort, so-called "triptan sensations," are often felt to be noncardiac. In Part 1 of this review, the relationship of triptans, coronary artery narrowing, and spasm was discussed, along with a case of a 53-year-old woman without cardiac risk factors who developed polymorphic ventricular tachycardia and cardiac ischemia with acquired corrected QT (QTc) interval prolongation following oral sumatriptan. In Part 2 of this review, headache medications, drug-drug interactions, QTc prolongation, and cardiac arrhythmias are appraised and discussed. Triptans, cardiac arrhythmias, and ischemia by prescribing information are summarized. The reader is provided tables on QTc prolongation by medication. The problem of QTc prolongation with a variety of headache medications at conventional doses, including triptans, serotonin reuptake inhibitors (selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors), other antidepressants, antihistamines, and antinauseants should lead to proactively obtaining electrocardiograms and more vigilant surveillance of headache patients. This may be the place to start in protecting patients from these cardiac adverse events.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

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