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

• Published in: Headache 2013-01, Vol.53 (1), p.217-224
• Main Authors: Stillman, Mark J., Tepper, Deborah E., Tepper, Stewart J., Cho, Leslie
• Format: Article
• Language: English
• Subjects: Antidepressants; Antihistamines; Arrhythmia; Arrhythmias, Cardiac - chemically induced; Arteries; Cardiac arrhythmia; Chest; Coronary artery; Coronary Vasospasm - chemically induced; corrected QT prolongation; Discomfort; Drug Interactions; Drug therapy; Drugs; EKG; Electrocardiography - drug effects; Female; Headache; Headache - drug therapy; Headaches; Heart; Heart diseases; Humans; Inhibitors; Ischemia; Jaw; Middle Aged; migraine medication; Myocardial ischemia; Myocardial Ischemia - chemically induced; Norepinephrine; Patients; polymorphic ventricular tachycardia; Prinzmetal angina; Prolongation; Reviews; Risk analysis; Risk factors; Serotonin; Serotonin Receptor Agonists - adverse effects; Serotonin uptake inhibitors; Sumatriptan; Tachycardia; Torsade de Pointes; torsades de pointes; Torsades de Pointes - chemically induced; triptan; Vasoconstriction; vasospasm; Ventricle
• ISSN: 0017-8748; 1526-4610
• DOI: 10.1111/j.1526-4610.2012.02299.x

Serotonin (5‐hydroxytryptamine)1B/1D 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.