Interaction between
Furazolidone
and
Sumatriptan
Major
Metabolism
Basic Information
| ID | DDInter2064 and DDInter1730 |
| Interaction | Monoamine oxidase inhibitors (MAOIs) may significantly elevate the plasma concentrations of certain 5-HT1 receptor agonists (namely rizatriptan, sumatriptan, and zolmitriptan) and their active metabolites by inhibiting their metabolic clearance via monoamine oxidase, subtype A. Clinically, this interaction may increase the risk of vasospastic reactions, including coronary artery vasospasm, peripheral vascular ischemia and colonic ischemia, associated with the use of 5-HT1 receptor agonists. Although the pharmacokinetic alterations are observed only with a limited number of 5-HT1 receptor agonists and their metabolites, the possibility of a pharmacodynamic interaction should be considered for all agents in the class, since they exhibit modest 5-HT1A activity. |
| Management | Concomitant use of rizatriptan, sumatriptan, or zolmitriptan with MAOIs or other agents that possess MAOI activity (e.g., furazolidone, linezolid, methylene blue, procarbazine) is considered contraindicated. At least 14 days should elapse between discontinuation of MAOI therapy and initiation of treatment with 5-HT1 receptor agonists. If concurrent therapy is necessary, almotriptan, frovatriptan and naratriptan may be preferred due to the lack of a significant pharmacokinetic interaction with MAOIs. However, patients should be closely monitored for adverse effects related to excessive serotonergic activity. |
| References | [1] Pettinger WA, Soyangco FG, Oates JA "Inhibition of monoamine oxidase in man by furazolidone." Clin Pharmacol Ther 9 (1968): 442-7 [2] Nierenberg DW, Semprebon M "The central nervous system serotonin syndrome." Clin Pharmacol Ther 53 (1993): 84-8 [3] Sternbach H "The serotonin syndrome." Am J Psychiatry 148 (1991): 705-13 [4] "Product Information. Imitrex (sumatriptan)." Glaxo Wellcome (2001): [5] Diamond S "The use of sumatriptan in patients on monoamine oxidase inhibitors." Neurology 45 (1995): 1039-40 [6] De Vita VT, Hahn MA, Oliverio VT "Monoamine oxidase inhibition by a new carcinostatic agent, n-isopropyl-a-(2-methylhydrazino)-p-toluamide (MIH). (30590)." Proc Soc Exp Biol Med 120 (1965): 561-5 [7] "Product Information. Zomig (zolmitriptan)." Astra-Zeneca Pharmaceuticals (2001): [8] Mills KC "Serotonin syndrome: A clinical update." Crit Care Clin 13 (1997): 763 [9] "Product Information. Maxalt (rizatriptan)." Merck & Co., Inc (2001): [10] Gardner DM, Lynd LD "Sumatriptan contraindications and the serotonin syndrome." Ann Pharmacother 32 (1998): 33-8 [11] Chan BSH, Graudins A, Whyte IM, Dawson AH, Braitberg G, Duggin GG "Serotonin syndrome resulting from drug interactions." Med J Aust 169 (1998): 523-5 [12] Fleishaker JC, Ryan KK, Jansat JM, et al. "Effect of MAO-A inhibition on the pharmacokinetics of almotriptan, an antimigraine agent in humans." Br J Clin Pharmacol 51 (2001): 437-41 [13] Martin TG "Serotonin syndrome." Ann Emerg Med 28 (1996): 520-6 |
| Alternative for Furazolidone |
G01A
|
| Alternative for Sumatriptan |
N02C
G01A |
Potential Metabolism Interactions
Substrate-Substrate Interaction：If more than one drug is metabolized by the same CYP, it is possible that its metabolism is inhibited because of the competition between the drugs. That means, it can be useful to lower the dosage of the drugs in the drug-cocktail because they remain longer in the organism than in monotherapy.
Inhibitor-Inhibitor Interaction：Combining two or more inhibitors of one CYP, should be compensated by lowering the dosage of these drugs because the metabolism is reduced and the drugs remain longer in the organism than in monotherapy. Not adapting the dosage bears the risk of even more side effects.
Inhibitor-Substrate Interaction：Combining drugs that have inhibitory effect and are substrates of one particular CYP, should be compensated by lowering the dosage. They rest longer in the organism than in monotherapy. Not adapting the dosage bears the risk of even more side effects.