TRIPTANS FOR RAYNAUD'S OR SULFA ALLERGY
November 2000
I. GRYMONPRE, MD, of Nelson, BC, writes: "Are triptans for migraines contraindicated in patients with Raynaud's disease? If a patient is allergic to sulfa drugs, is there a risk of an allergic reaction to all triptans, or just sumatriptan (Imitrex)?"
As you've suggested, triptans are indeed at least relatively contraindicated in patients who have Raynaud's, due to the potential vasospastic properties of these medications. It's been suggested that patients with a definite allergy to sulfa drugs are at risk of developing an allergic reaction to sumatriptan (Imitrex) and naratriptan (Amerge), since both of these compounds contain a sulfonamide group. This was confirmed in recent discussions with Glaxo Wellcome Inc. (Canada), the manufacturer of these drugs. Interestingly, the Food and Drug Administration (FDA) in the U.S. removed this precaution in 1994. Since zolmitriptan (Zomig) and rizatriptan (Maxalt) apparently don't contain these sulfonamide groups, they shouldn't pose a risk of allergic reaction -- theoretical or otherwise -- in patients with a preexisting sulfonamide allergy. LW
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