What Cannot Be Taken With Sumatriptan? A Comprehensive Guide to Drug Interactions

October 11, 2025 •

4 min read

Over 1 billion people worldwide suffer from migraines, and sumatriptan is a common treatment for moderate to severe attacks. However, knowing what cannot be taken with sumatriptan is critical to avoid serious drug interactions that can lead to life-threatening conditions like serotonin syndrome or excessive vasoconstriction.

Quick Summary

Sumatriptan interacts dangerously with several drug classes, including MAOIs, ergot-containing drugs, and other triptans, requiring specific waiting periods to prevent complications. Risks include excessive vasoconstriction and a dangerous buildup of serotonin, which mandates careful timing or total avoidance of certain medications.

Key Points

Monoamine Oxidase Inhibitors (MAOIs): Do not take sumatriptan within 14 days of using an MAOI due to the risk of dangerous serotonin syndrome and toxic sumatriptan levels.
Other Triptan Medications: Avoid taking sumatriptan within 24 hours of using another triptan to prevent additive vasoconstrictive effects, which can cause heart attack or stroke.
Ergot-Containing Drugs: Combining sumatriptan with ergot derivatives is dangerous and can cause severe vasoconstriction and high blood pressure; a 24-hour waiting period is required.
Serotonergic Medications: Using sumatriptan alongside SSRIs, SNRIs, certain opioids, or St. John's Wort increases the risk of developing serotonin syndrome.
Communicate with a Healthcare Provider: Always provide a complete list of medications and supplements to your doctor to prevent potentially life-threatening drug interactions with sumatriptan.
Recognize Warning Signs: Be aware of symptoms of serotonin syndrome (confusion, agitation, rapid heart rate) or excessive vasoconstriction (chest pain, numbness) and seek immediate medical help if they occur.

Sumatriptan, a medication primarily used to treat acute migraine and cluster headaches, belongs to a class of drugs called triptans. It works by mimicking the natural brain chemical serotonin to cause blood vessels in the brain to constrict, which helps alleviate the pain and other symptoms associated with a migraine. While effective, its mechanism of action means it can interact dangerously with other medications that affect serotonin levels or blood vessel constriction. Patients and healthcare providers must be vigilant about these interactions to ensure safe and effective treatment. The consequences of these interactions can range from increased side effects to severe, life-threatening events.

Key Drug Interactions to Avoid with Sumatriptan

Several classes of drugs are known to have significant and potentially severe interactions with sumatriptan. These interactions can lead to dangerously high serotonin levels, excessive blood vessel constriction, or a buildup of sumatriptan in the body, increasing the risk of serious side effects.

Monoamine Oxidase Inhibitors (MAOIs)

MAOIs are antidepressants and treatments for Parkinson's disease that inhibit the enzyme monoamine oxidase, which is responsible for breaking down sumatriptan. Taking sumatriptan while on or within a few weeks of stopping an MAOI can cause sumatriptan levels to build up to toxic concentrations, significantly increasing the risk of side effects, including serotonin syndrome.

Examples of MAOIs to avoid: isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate), rasagiline (Azilect), and selegiline (Emsam).
Crucial timing: Patients must not take sumatriptan within 14 days of using an MAOI.

Other Triptan Medications

Using sumatriptan with other triptans, another class of migraine drugs, is contraindicated because they all work by causing blood vessels to constrict. Combining them can lead to an excessive narrowing of blood vessels, posing a risk of heart attack, stroke, or other serious cardiovascular events.

Examples of other triptans: almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), and zolmitriptan (Zomig).
Important safety period: Do not take another triptan within 24 hours of taking sumatriptan.

Ergot-Containing Drugs

Like triptans, ergot derivatives also cause widespread vasoconstriction. The combination of sumatriptan and an ergot-containing medication can result in dangerously high blood pressure and other cardiovascular issues due to their additive effects on blood vessels.

Examples of ergot-containing drugs: ergotamine (Ergomar), dihydroergotamine (D.H.E. 45), methylergonovine (Methergine), and methysergide.
Strict timing: Avoid taking sumatriptan within 24 hours of using an ergotamine-type medication.

Other Serotonergic Drugs

Sumatriptan increases serotonin activity, and combining it with other medications that also increase serotonin can lead to serotonin syndrome, a potentially life-threatening condition.

Examples of serotonergic drugs: Selective Serotonin Reuptake Inhibitors (SSRIs) like fluoxetine and sertraline, Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs) like venlafaxine and duloxetine, certain opioids like tramadol, and the herbal supplement St. John's Wort.

Serotonin Syndrome and Vasoconstriction: Understanding the Dangers

Understanding the specific risks associated with sumatriptan interactions highlights the importance of caution. Serotonin syndrome is a serious condition that can result from excessive serotonin levels. Symptoms include confusion, agitation, hallucinations, rapid heart rate, muscle stiffness, and uncontrolled shaking. Excessive vasoconstriction, or the narrowing of blood vessels, can lead to more serious issues like heart attack, stroke, or peripheral vascular disease, which can cause pain or numbness in the limbs.

Comparison of Major Sumatriptan Interactions


Medication Class	Example Medications	Reason for Interaction	Risk	Required Waiting Period (from sumatriptan)
MAOIs	Isocarboxazid, phenelzine, selegiline	Impaired metabolism of sumatriptan, raising plasma levels.	Significantly increased risk of serotonin syndrome.	14 days before starting sumatriptan.
Other Triptans	Rizatriptan, zolmitriptan, eletriptan	Additive vasoconstrictive effects.	Excessive blood vessel narrowing, potential heart attack or stroke.	24 hours before or after taking sumatriptan.
Ergot Derivatives	Ergotamine, dihydroergotamine	Additive vasoconstrictive effects.	Excessive blood vessel narrowing, potential heart attack or stroke.	24 hours before or after taking sumatriptan.
Serotonergic Drugs	SSRIs, SNRIs, tramadol, St. John's Wort	Increased serotonin activity.	Increased risk of serotonin syndrome.	Varies; discuss with a doctor for specific medications.

What to Discuss with Your Doctor

Before starting sumatriptan, it is crucial to provide a complete list of all medications, supplements, and herbal remedies you are taking. Be honest about your health history, including any history of heart disease, high blood pressure, liver problems, or seizures. If you experience any symptoms of serotonin syndrome or severe vasoconstriction, stop taking sumatriptan and seek immediate medical attention. Your healthcare provider can determine the appropriate course of action and find a safer alternative if necessary.

Conclusion

While sumatriptan offers significant relief for migraine sufferers, it is not without risks, particularly concerning drug interactions. Certain medications, such as MAOIs, other triptans, and ergot-containing drugs, are strictly contraindicated for concurrent use due to the high risk of severe complications like serotonin syndrome and excessive vasoconstriction. Even some antidepressants and herbal supplements require careful consideration. Always maintain open communication with your healthcare provider to ensure your treatment plan is safe and tailored to your individual needs. Never start, stop, or change medications without first consulting your doctor or pharmacist. For further information, the MedlinePlus drug information page for Sumatriptan is an authoritative resource.

Frequently Asked Questions

Combining sumatriptan with SSRIs, like fluoxetine or sertraline, increases the risk of a rare but serious condition called serotonin syndrome. You must discuss this with your doctor, who will weigh the risks and benefits. They may recommend an alternative or advise careful monitoring.

Taking sumatriptan and another triptan (e.g., rizatriptan or zolmitriptan) within 24 hours can lead to excessive narrowing of blood vessels. This can increase the risk of serious cardiovascular problems like heart attack or stroke.

You must wait at least 14 days after stopping a monoamine oxidase inhibitor (MAOI) before taking sumatriptan. MAOIs prevent the breakdown of sumatriptan, which can lead to dangerously high levels of the drug in your body.

No, it is not safe. Ergotamine and sumatriptan both cause blood vessels to constrict. Taking them together can cause dangerously excessive blood vessel narrowing and lead to severe side effects. You should not take sumatriptan within 24 hours of using an ergot-containing drug.

No, you should not take St. John's Wort with sumatriptan. St. John's Wort can increase serotonin levels, and when combined with sumatriptan, it raises the risk of serotonin syndrome.

Symptoms can include confusion, agitation, rapid heartbeat, fever, shivering, excessive sweating, muscle stiffness, and uncontrolled muscle movements. If you experience these symptoms, seek emergency medical help immediately.

While alcohol doesn't have a direct drug interaction with sumatriptan, it can be a common migraine trigger. Limiting or avoiding alcohol, especially during a migraine attack, is often recommended.