Sumatriptan
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Ischaemic colitis: case report A 35-year-old woman developed ischaemic colitis following overuse of sumatriptan [usual dosage and duration of treatment to reaction onset not stated]. The woman presented after experiencing 6 hours of severe abdominal pain (rated 10/10) and nausea. During the 3 days prior to abdominal pain, she had experienced an intense refractory migraine headache and she estimated that she had taken 300mg of oral sumatriptan and 12mg of SC sumatriptan; she had also taken one dose of ibuprofen 800mg 72 hours before presentation. She had a soft abdomen, which was diffusely tender on palpation with voluntary guarding. She had an elevated WBC count (19.2 × 103 /mcL) with a left shift. CT scans demonstrated diffuse wall thickening of her left colon; findings were consistent with acute colitis. The woman received hydromorphone and ondansetron, which reduced her pain (8/10). She was diagnosed with colitis and discharged on metronidazole, hydrocodone/ paracetamol [acetaminophen] and levofloxacin. She was instructed that she could continue taking her previously prescribed medications, including sumatriptan. Her abdominal pain and severe headache persisted. Within a few hours of discharge, she re-presented to her physician. She was hospitalised for pain management and was prescribed bowel rest, morphine, IV hydration and levofloxacin. She also received IV dexamethasone and valproic acid and her headache resolved. During the following 72 hours, her nausea and abdominal pain gradually improved and, at discharge, they had completely resolved. Her WBC count also returned to normal. A few days later, she re-presented for a colonoscopy, which revealed a granular and erythematous appearance of the sigmoid colon; biopsy findings were consistent with acute colitis. Author comment: "Given the temporal relationship between the use of large doses of sumatriptan and the onset of our patient’s symptoms, the lack of infectious signs and symptoms, and the negative IBD studies, the gastroenterologist and the admitting team felt confident that the most likely diagnosis was ischemic colitis directly related to the use of sumatriptan." Hodge JA, et al. Ischemic colitis related to sumatriptan overuse. Journal of the American Board of Family Medicine 23: 124-127, No. 1, Jan-Feb 2010. Available 803007911 from: URL: http://dx.doi.org/10.3122/jabfm.2010.01.090086 - USA
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Reactions 20 Mar 2010 No. 1293
