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Co-Prescription of Triptans with Other Medications:
A Cohort Study Involving 240,288 Patients
S Tepper, C Allen, D Sanders, A Greene, S Boccuzzi
Posted: March 2003  
Headache Quarterly 2002; 13.3:26

This study examined the rate of co-prescription of triptans currently available in the US (sumatriptan, naratriptan, rizatriptan, and zolmitriptan) with specified agents with potential for drug interactions. A cohort of 240,288 patients receiving pharmacy benefits from Merck-Medco was followed over a 1-year period. This analysis included patients who received at least two triptan prescriptions during the study (6/00 to 5/01).

Ninety-one percent of the cohort remained on the same triptan during the study period. "Co-prescription" was defined as any fill for a select medication obtained between the first and last triptan fills during the study period. Mean patient age was 43, and 82 percent were female. Twenty-six percent were co-prescribed selective serotonin reuptake inhibitors, reflecting the considerable comorbidity of migraine and depression. Patients taking triptans were almost never co-prescribed monoamine oxidase inhibitors and co-prescription of ergots was also low. Less than one percent received cimetidine while taking zolmitriptan; 2.7 percent of patients taking rizatriptan 10 mg. also took propranolol.

While agents unavailable in the US were not evaluated in this cohort, 6 percent of patients were treated with potent CVP 34A inhibitors, which would not be expected to cause any problems with the triptans in the survey. However, such agents are specifically contraindicated for use with one triptan (eletriptan), recently launched in the EU, suggesting that continued vigilance will be necessary to avoid co-prescription of medicines with the potential for producing adverse drug events.