The use of triptans in cardiovascular diseases

In vitro, triptans constrict both brain vessels and coronary vessels, but their activity is 10 times higher in cerebral vessels than in vessels of the heart.

In patients with ischemic heart disease, stroke or suffering from uncontrolled arterial hypertension, use of triptans and ergotamine preparations is contraindicated, since they constrict coronary vessels in the laboratory. The degree of vasoconstriction is low, so triptans and ergotamines can be used in patients with migraine.

Sumatriptan, administered intravenously or subcutaneously, increases the systemic pressure and pressure in the pulmonary artery, and also increases the resistance of the vascular wall, without affecting the cardiac output.

The diameter of the coronary artery is reduced by 13% 10 minutes after intravenous injection, by 16% 10 minutes after subcutaneous injection and by 17% 30 minutes after subcutaneous injection. In practically healthy people suffering from migraine, after administration of suma-triptan at a dose of 6 mg, myocardial perfusion is slightly reduced, although these changes are not statistically and clinically significant.

Due to the increased risk of cardiovascular disease in people suffering from migraine, the occurrence of cardiovascular diseases in patients taking triptans may be associated with treatments that increase the risk, or with other factors.

Jhee et al. investigated the frequency of cardiovascular disorders in patients taking placebo. On ECG, 67% of the subjects showed abnormalities. This study showed how important is the assessment of the cardiovascular parameters of patients in the placebo group or those who did not receive treatment; conduct to avoid overdiagnosis of cardiac pathology due to treatment.

Headache experts analyzed the results of large studies that did not reveal any correlation between the use of triptans and the risk of developing strokes or myocardial infarction. Frequent use of triptans did not increase the risk of cardiovascular complications, and with frequent use of ergotamine preparations, the risk increased (OR = 2.55, 95% CI = 1.22-5.36).

local_offerevent_note February 10, 2019

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