Common drugs may cause stroke in rare cases

[Guest guest]

Common drugs may cause stroke in rare cases

By Merritt McKinney

NEW YORK, Jan 07 (Reuters Health) - In rare cases, drugs that act on the

brain chemical serotonin, including some antidepressants, decongestants

and migraine medications, may trigger a stroke, researchers report.

But the research does not mean that the millions of people who take

serotonin-enhancing medications need to stop, according to Dr. Walter J.

Koroshetz of Massachusetts General Hospital in Boston.

The link between the drugs and stroke is " very preliminary, " he told

Reuters Health in an interview. Even if the medications, particularly in

combination, can trigger a stroke, " my guess is that it is incredibly

rare, " he added.

But in the event of a sudden, intensely painful headache-- " the worst

headache that you've ever had " --seek immediate medical attention,

Koroshetz said.

Koroshetz explained that thunderclap headaches, which he likened to a

" bolt of lightning, " can result from subarachnoid hemorrhage, or

bleeding from a ruptured blood vessel in the brain.

In a report in the January issue of the journal Neurology, Koroshetz and

his colleagues describe three people who experienced thunderclap

headaches and stroke after taking one or more serotonin-enhancing

medications.

One patient, who was taking several serotonin-enhancing antidepressants,

experienced a sudden " worst ever " headache with blurred vision 2 days

after she started taking an over-the-counter cold medication that

contained dextromethorphan hydrobromide and guaifenesin. A second woman,

who was taking a type of antidepressant called an SSRI that affects the

brain's serotonin system, developed an " explosive " headache with nausea

an hour after she took a cold remedy containing dextromethorphan

hydrobromide and pseudoephedrine.

Doctors first suspected that the symptoms were caused by a subarachnoid

hemorrhage, but imaging tests performed during the weeks after the

beginning of symptoms showed that the women had experienced several

strokes.

In both cases, doctors determined that the strokes occurred when blood

vessels in the brain became narrowed, presumably by serotonin-enhancing

drugs.

After the first woman stopped taking the antidepressant and the cold

medication, her symptoms improved. Symptoms also cleared up when the

second patient stopped taking an antidepressant, but she began having

recurring headaches after being prescribed another antidepressant

several months later. These headaches disappeared when she stopped

taking this drug.

Koroshetz and his colleagues also report the case of a third patient

whose brain blood vessels narrowed after he had a thunderclap headache.

The man was not taking any prescription or over-the-counter medications

regularly, and he did not use illegal drugs. His headache improved after

treatment with several medications including sumatriptan, a drug used to

treat migraine headaches that is sold under the name Imitrex.

Over the next few days he continued having headaches, however. After he

received a second dose of sumatriptan, the man had a seizure. Although

tests used to detect a stroke were negative, doctors detected signs of

narrowed blood vessels in his brain. His headache symptoms cleared up on

their own within a week.

A variety of drugs act on the serotonin system in the brain, including

antidepressants, migraine drugs, decongestants, diet pills,

amphetamines, herbal remedies such as St. 's wort, the illegal drug

Ecstasy, cocaine and methamphetamine.

The report does not prove that serotonin-enhancing drugs caused the

symptoms, according to Koroshetz. However, he noted that there is some

evidence that serotonin can cause blood vessels to go into spasm.

The researchers suspect that, in the first two patients, the combination

of antidepressants that keep the brain from clearing serotonin with cold

medicine containing a serotonin-boosting stimulant may have triggered

the thunderclap headaches.

The key message of the report, Koroshetz said, is not to avoid

medications that affect serotonin, but to be " even more alert than

usual " if a sudden, very severe headache strikes.

" Seek attention and don't wait it out, " he said. Even after the headache

subsides, if the cause of the headache is subarachnoid hemorrhage, the

risk of death without treatment is very high, he noted.

Ramona DuBose, a spokesperson for GlaxoKline, which makes the

migraine

drug sumatriptan, agreed with the study authors that anybody with an

unexplained thunderclap headache should seek medical attention. " But we

would caution against drawing any conclusions " about sumatriptan and

seizures based on one patient, she told Reuters Health in an interview.

She noted that seizure has been reported only rarely among users of

sumatriptan.

SOURCE: Neurology 2002;58:130-133.

[Guest guest]

This one is very important. I don't take cold meds with my amitriptyline and

paxil. It says right on my info page from my pharmacist that you should NOT

take those together. In the cases below, I find the doctor's at fault.

Thank you, !

~Rainy

[ ] Common drugs may cause stroke in rare cases

> Common drugs may cause stroke in rare cases

>

> By Merritt McKinney

>

> NEW YORK, Jan 07 (Reuters Health) - In rare cases, drugs that act on the

> brain chemical serotonin, including some antidepressants, decongestants

> and migraine medications, may trigger a stroke, researchers report.

>

> But the research does not mean that the millions of people who take

> serotonin-enhancing medications need to stop, according to Dr. Walter J.

> Koroshetz of Massachusetts General Hospital in Boston.

>

> The link between the drugs and stroke is " very preliminary, " he told

> Reuters Health in an interview. Even if the medications, particularly in

> combination, can trigger a stroke, " my guess is that it is incredibly

> rare, " he added.

>

> But in the event of a sudden, intensely painful headache-- " the worst

> headache that you've ever had " --seek immediate medical attention,

> Koroshetz said.

>

> Koroshetz explained that thunderclap headaches, which he likened to a

> " bolt of lightning, " can result from subarachnoid hemorrhage, or

> bleeding from a ruptured blood vessel in the brain.

>

> In a report in the January issue of the journal Neurology, Koroshetz and

> his colleagues describe three people who experienced thunderclap

> headaches and stroke after taking one or more serotonin-enhancing

> medications.

>

> One patient, who was taking several serotonin-enhancing antidepressants,

> experienced a sudden " worst ever " headache with blurred vision 2 days

> after she started taking an over-the-counter cold medication that

> contained dextromethorphan hydrobromide and guaifenesin. A second woman,

> who was taking a type of antidepressant called an SSRI that affects the

> brain's serotonin system, developed an " explosive " headache with nausea

> an hour after she took a cold remedy containing dextromethorphan

> hydrobromide and pseudoephedrine.

>

> Doctors first suspected that the symptoms were caused by a subarachnoid

> hemorrhage, but imaging tests performed during the weeks after the

> beginning of symptoms showed that the women had experienced several

> strokes.

>

> In both cases, doctors determined that the strokes occurred when blood

> vessels in the brain became narrowed, presumably by serotonin-enhancing

> drugs.

>

> After the first woman stopped taking the antidepressant and the cold

> medication, her symptoms improved. Symptoms also cleared up when the

> second patient stopped taking an antidepressant, but she began having

> recurring headaches after being prescribed another antidepressant

> several months later. These headaches disappeared when she stopped

> taking this drug.

>

> Koroshetz and his colleagues also report the case of a third patient

> whose brain blood vessels narrowed after he had a thunderclap headache.

> The man was not taking any prescription or over-the-counter medications

> regularly, and he did not use illegal drugs. His headache improved after

> treatment with several medications including sumatriptan, a drug used to

> treat migraine headaches that is sold under the name Imitrex.

>

> Over the next few days he continued having headaches, however. After he

> received a second dose of sumatriptan, the man had a seizure. Although

> tests used to detect a stroke were negative, doctors detected signs of

> narrowed blood vessels in his brain. His headache symptoms cleared up on

> their own within a week.

>

> A variety of drugs act on the serotonin system in the brain, including

> antidepressants, migraine drugs, decongestants, diet pills,

> amphetamines, herbal remedies such as St. 's wort, the illegal drug

> Ecstasy, cocaine and methamphetamine.

>

> The report does not prove that serotonin-enhancing drugs caused the

> symptoms, according to Koroshetz. However, he noted that there is some

> evidence that serotonin can cause blood vessels to go into spasm.

>

> The researchers suspect that, in the first two patients, the combination

> of antidepressants that keep the brain from clearing serotonin with cold

> medicine containing a serotonin-boosting stimulant may have triggered

> the thunderclap headaches.

>

> The key message of the report, Koroshetz said, is not to avoid

> medications that affect serotonin, but to be " even more alert than

> usual " if a sudden, very severe headache strikes.

>

> " Seek attention and don't wait it out, " he said. Even after the headache

> subsides, if the cause of the headache is subarachnoid hemorrhage, the

> risk of death without treatment is very high, he noted.

>

> Ramona DuBose, a spokesperson for GlaxoKline, which makes the

> migraine

>

> drug sumatriptan, agreed with the study authors that anybody with an

> unexplained thunderclap headache should seek medical attention. " But we

> would caution against drawing any conclusions " about sumatriptan and

> seizures based on one patient, she told Reuters Health in an interview.

> She noted that seizure has been reported only rarely among users of

> sumatriptan.

>

> SOURCE: Neurology 2002;58:130-133.