Do you avoid triptans in patients on SSRIs due to the potential risk of serotonin syndrome?

I feel very comfortable using triptans with SSRIs/SNRIs.

In 2010, the American Headache Society released a position statement on this very issue:

Evans et al., PMID 20618823

Their position is that the available evidence does NOT support the claim that triptans should not be used with SSRIs or SNRIs.

A 2012 publication looked at co-triptan and SSRI/SNRI prescribed between 2003-2004 and 2007-2008. They found an annualized mean of 1,319,763 patients simultaneously prescribed these drug classes. In a 2020 cross-sectional study of the National Poison Data System 2014-2018 of n=1489 subjects overdoses, there were n=328 with overdoses that included triptans. None of the cases met Hunter's criteria for serotonin syndrome. A 2023 study of 86,109 tripta...

Almost never. If someone was on huge doses of one or both drugs I might think about it. For about 25 years or more, I have gotten calls from pharmacies about prescribing the 2 together and I have said thank you, I will think more about it, but I do not believe there is a significant risk of serotonin syndrome when using both categories of drug.

Dr. Stewart Tepper, a friend and colleague, knows more about this and has written about it and I hope will supply an answer.

Alan Rapoport, M.D.

I agree with the above and in 25 years of practice and seeing thousands of patients with headaches, I never saw serotonin syndrome.

The short answer to this question is, NO. Triptans have very poor CNS penetration and are highly selective in their interaction with serotonin receptors. I am much more concerned about psychiatrists having patients on multiple medications that act on the serotonin system.

There is a warning but I have never experienced serotonin syndrome as a side effect in any of my patients. Most of my adolescent patients are already on SSRIs.

First things first, we’ve got to stop using the terminology ‘serotonin syndrome’. We’re talking about serotonin toxicity. My understanding is outside of the MAOI/SSRI (or SNrI) combination, serotonin toxicity is extremely rare. It requires blocking reuptake inhibition at two separate sites. Fatal toxicity is exceedingly rare on a single agent even pushed to an extremely high dose. I would encourage anyone on here to check out Ken Gillman’s website (PsychoTropical.com) as he is one of (if not the) world experts on serotonin toxicity, as well as MAOIs.

All of the EMR alert systems I’ve worked with are extremely vigilant about serotonin toxicity, even noting every time I prescribe lithium that it may precipitate toxicity in combination with an...

I agree with the comments, here is another recent article about the topic published by one of my colleagues:

Orlova et al., PMID 29482205