OBJECT DRUGS

• Almotriptan (Axert)
• Eletriptan (Relpax)

PRECIPITANT DRUGS

Antidepressants:

• Fluvoxamine (Luvox, etc.)
• Nefazodone

Comment:

Almotriptan and eletriptan are CYP3A4 substrates, and CYP3A4 inhibitors such as fluvoxamine or nefazodone may increase the risk of toxicity. Hypertension, tachycardia or coronary vasospasm may occur if administered with CYP3A4 inhibitors.

Class 2: Use Only if Benefit Felt to Outweigh Risk

• Use Alternative:
• Triptans: Naratriptan (Amerge), Zolmitriptan (Zomig), and Sumatriptan (Imitrex), are not CYP3A4 substrates.
• Antidepressants: Sertraline (Zoloft), venlafaxine (Effexor), paroxetine (Paxil), citalopram (Celexa), and escitalopram (Lexapro) are not known to inhibit CYP3A4. Fluoxetine (Prozac) appears to be a weak CYP3A4 inhibitor.
• Monitor: If the combination is used, monitor for evidence of vasoconstriction such as hypertension.