Imitrex interactions: Alcohol, medications, and other factors

Imitrex (sumatriptan) is a brand-name prescription drug used to treat migraine with or without aura in adults. The injectable form of Imitrex can also be used to treat cluster headache in adults.

As with other medications, Imitrex can interact with certain other drugs. It can also interact with some supplements. An interaction occurs when one substance causes another substance to have a different effect than expected.

Imitrex comes in different forms, which have the same interactions. The forms are:

• solution for subcutaneous injection
• oral tablet
• nasal spray

For details about Imitrex’s interactions, including what you can’t take with Imitrex, keep reading. For additional information about Imitrex, including facts about its uses and limitations of use, see this article.

In some cases, factors or conditions could prevent your doctor from prescribing Imitrex due to the risk of harm. These are known as contraindications. The contraindications of Imitrex include the ones mentioned below.

Note: Before you start treatment with Imitrex, it’s important to tell your doctor if any of these contraindications apply to you. They can determine whether to prescribe Imitrex. Also, many of these contraindications involve side effects of Imitrex. To learn more about the drug’s side effects, see this article.

Having or having had heart disease

Before taking Imitrex, tell your doctor if you have or have had heart disease. Imitrex can cause irregular heart rates and heart attack. Having or having had heart disease can increase the risk of these side effects. Due to the risk, doctors typically will not prescribe Imitrex if you have coronary artery disease or coronary artery vasospasm. (These are types of heart problems.) Instead, your doctor will usually recommend a different treatment option.

Having an electrical problem in your heart

If you have an electrical problem in your heart, such as Wolff-Parkinson-White syndrome, talk with your doctor before taking Imitrex.

Trouble with the heart’s electricity can cause problems that affect your heartbeat. Imitrex itself can cause heart problems such as irregular heart rate and heart attack. If you have or have had an electrical problem in your heart, you’re likely at an increased risk of these side effects. Due to the risk, doctors typically will not prescribe Imitrex if you have an electrical problem in your heart. They’ll usually suggest a different treatment instead.

Having a history of stroke

If you have ever had a stroke or transient ischemic attack (TIA), which is also called a ministroke, tell your doctor before taking Imitrex. Taking the drug may increase your risk of having a stroke. Having had a stroke or TIA can further increase your risk. Because of this, doctors usually won’t prescribe Imitrex if you’ve had stroke or TIA. You’ll likely be prescribed another medication.

Having blood pressure that’s not well managed

If you have high blood pressure that’s not well managed, talk with your doctor before taking Imitrex. The medication may increase your blood pressure. If you already have blood pressure that’s not well managed, taking Imitrex may raise it further. This can increase your risk of more serious conditions, such as heart attack or stroke. In this case, your doctor will likely recommend a different treatment for your condition.

Having hemiplegic or basilar migraine

If you have certain types of migraine, called hemiplegic or basilar migraine, tell your doctor before taking Imitrex.

These conditions may cause weakness on one side of your body, slurred speech, or double vision. These types of migraine may also increase your risk of having a stroke. Taking Imitrex may increase your risk of having a stroke as well. So, if you have hemiplegic or basilar migraine and take Imitrex, your risk could increase further.

Because of this, doctors usually won’t prescribe Imitrex if you have hemiplegic or basilar migraine. You’ll usually be prescribed a different treatment option.

Having severe liver disease

Before taking Imitrex, tell your doctor about any liver problems you have. Imitrex is removed from your body by your liver. If your liver isn’t working as well as it should, the drug can build up in your body. This can increase your risk of side effects. Because of this, if you have a severe liver condition such as liver failure, your doctor will likely recommend a different treatment option.

Having peripheral vascular disease

Before taking Imitrex, tell your doctor if you have peripheral vascular disease (PVD). This is a condition that can cause narrowing of your arteries or veins. Imitrex works by narrowing your blood vessels, so it can make PVD worse. Due to the possible risk, doctors usually won’t prescribe Imitrex if you have PVD. They can recommend a different treatment for you.

Having ischemic bowel disease

If you have ischemic bowel disease, tell your doctor before taking Imitrex. This disease can cause decreased blood flow to your intestines. Imitrex works by narrowing your blood vessels, so it can make ischemic bowel disease worse. Due to the possible risk, your doctor usually won’t prescribe Imitrex if you have ischemic bowel disease. You’ll likely be prescribed a different treatment.

Having recently taken another triptan medication or an ergotamine

Imitrex is a type of drug called a triptan. Imitrex works like other triptans and medications called ergotamines. Triptans and ergotamines are often used to treat migraine and cluster headache.

If you’ve taken another triptan or ergotamine medication within the past 24 hours, tell your doctor before taking Imitrex. These medications work by narrowing blood vessels. Taking them in combination with Imitrex may cause your blood vessels to narrow too much. This could increase your risk of serious side effects, such as heart attack or stroke. Due to the risk, doctors typically won’t prescribe Imitrex if you’ve taken another triptan or ergotamine within the past 24 hours.

Examples of triptan and ergotamine medications include:

• almotriptan
• rizatriptan (Maxalt, Maxalt-MLT)
• eletriptan (Relpax)
• frovatriptan (Frova)
• dihydroergotamine (Migranal)
• ergotamine/caffeine (Migergot)
• ergotamine tartrate (Ergomar)
• methylergonovine (Methergine)

Your doctor and pharmacist can help determine whether any of the medications you take are triptans or ergotamines.

Having recently taken a monoamine oxidase inhibitor (MAOI)

If you’ve taken a monoamine oxidase inhibitor (MAOI) within the past 2 weeks, tell your doctor.

MAOIs can raise the level of Imitrex in your body. This may increase your risk of side effects from the drug. In addition, the combination of MAOIs and Imitrex can increase your risk of serotonin syndrome, which can be life threatening. (For details about the syndrome, see “Drug interactions in depth” below.) Due to these risks, if you’ve taken an MAOI within the past 2 weeks, your doctor will likely recommend a treatment other than Imitrex.

Examples of MAOIs include:

• linezolid (Zyvox)
• methylene blue (Provayblue)
• tranylcypromine (Parnate)
• phenelzine (Nardil)
• selegiline (Emsam)
• isocarboxazid (Marplan)

To help determine whether any of the drugs you take are MAOIs, talk with your doctor or pharmacist.

Having had an allergic reaction to Imitrex or any of its ingredients

If you have had an allergic reaction to Imitrex or any of its ingredients, your doctor will likely not prescribe Imitrex. Taking the drug could cause another allergic reaction. You can ask them about other treatments that may be better choices for you.

Before you start treatment with Imitrex, tell your doctor and pharmacist which prescription, over-the-counter, and other medications you take. By sharing this information with them, you may help prevent possible interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Here’s a chart of drugs that can interact with Imitrex. Keep in mind that this chart doesn’t include all drugs that may interact with Imitrex. Some of these interactions are described in detail just below in “Drug interactions in depth.”

* To learn more about the side effects of Imitrex, see this article.
† For more information, see “When to avoid Imitrex” above.

Here’s a closer look at certain drug interactions of Imitrex.

Other serotonergic drugs

Drugs that are serotonergic may increase the levels of a chemical in your body called serotonin. Serotonergic medications are often used to treat migraine and certain mental health conditions, such as depression. Imitrex is a type of serotonergic drug.

Interaction result. Taking Imitrex with another serotonergic drug may increase the risk of serious side effects, such as serotonin syndrome. (To learn more about the side effects of Imitrex, see this article.)

Interaction explained. Imitrex can increase the levels of serotonin in your body. If you take another drug that can also raise serotonin levels, the levels could become even higher. When serotonin levels become too high, it’s possible to develop a rare but serious side effect called serotonin syndrome. In some cases, it can be life threatening.

Examples of other serotonergic drugs. Here are some other serotonergic drugs that may interact with Imitrex:

• amphetamine salts (Adderall)
• dextromethorphan (Delsym)
• tramadol (ConZip)
• trazodone
• lisdexamfetamine (Vyvanse)
• escitalopram (Lexapro)
• fluoxetine (Prozac)

Steps you or your doctor may take. Before starting treatment with Imitrex, tell your doctor if you’re taking any serotonergic drugs. They and your pharmacist can help determine if any of your medications are serotonergic.

If you are taking a serotonergic drug, due to the risk of serotonin syndrome, your doctor may monitor you more frequently than usual. They may also monitor you more often when you first start treatment with either medication and if they increase your dose.

Your doctor may also want you to watch for symptoms of serotonin syndrome. These may include confusion, hallucinations, and a rapid heart rate. If you develop any of these symptoms, immediately see your doctor or seek emergency help.

Buspirone

Buspirone is a medication that may be used to treat anxiety.

Interaction result. Taking Imitrex in combination with buspirone may increase the risk of serotonin syndrome.

Interaction explained. Imitrex and buspirone can increase the levels of serotonin in your body. If you take both of these drugs, the levels could become even higher. When serotonin levels become too high, it’s possible to develop a rare but serious side effect called serotonin syndrome. In some cases, it can be life threatening.

Steps you or your doctor may take. If you take buspirone, tell your doctor before starting Imitrex treatment. They may monitor you more often than usual. They may also monitor you more frequently when you first begin treatment with either Imitrex or buspirone and if they increase your dose.

Your doctor may have you watch for symptoms of serotonin syndrome. These could include hallucinations, confusion, and a rapid heart rate. If you develop any of these symptoms, immediately see your doctor or seek emergency help.

Tricyclic antidepressants

Drugs called tricyclic antidepressants (TCAs) are used to treat depression.

Interaction result. Taking Imitrex with a TCA may increase the risk of serotonin syndrome.

Interaction explained. Imitrex and TCAs can increase the levels of serotonin in your body. If you take Imitrex and a TCA, the levels could become even higher. When serotonin levels become too high, it’s possible to develop a rare but serious side effect called serotonin syndrome. In some cases, it can be life threatening.

Examples of tricyclic antidepressants. Here are some TCAs that may interact with Imitrex:

• amitriptyline
• nortriptyline (Pamelor)
• doxepin (Silenor)

Steps you or your doctor may take. If you’re taking a TCA, tell your doctor before starting Imitrex treatment. They and your pharmacist can help determine whether any of your medications are TCAs.

If you are taking a TCA, because of the possibility of serotonin syndrome, your doctor may monitor you more frequently than usual. They may also monitor you more often when you first start treatment with the Imitrex or the TCA and if they increase your dose.

Your doctor may also want you to watch for symptoms of serotonin syndrome. These may include rapid heart rate, confusion, and hallucinations. If you develop any of these symptoms, immediately see your doctor or seek emergency help.

There aren’t any known interactions between Imitrex and alcohol. However, your doctor may recommend that you do not drink alcohol if you have migraine or cluster headache. This is because alcohol may make your condition worse. Alcohol could increase your risk of having migraine or cluster headache.

In addition, alcohol may worsen side effects of Imitrex. For example, Imitrex can cause flushing, dizziness, and nausea. Alcohol may also cause these effects. So, the combination of alcohol and Imitrex may increase your risk of these side effects.

If you’re interested in drinking alcohol while taking Imitrex, talk with your doctor. They can help determine whether the combination may be safe for you.

Imitrex may have other interactions, such as with supplements, foods, vaccines, or even lab tests. You’ll find details below. Keep in mind that the following information does not include all other possible interactions with Imitrex.

Imitrex interactions with supplements

Before you start treatment with Imitrex, tell your doctor and pharmacist which supplements, herbs, and vitamins you take. By sharing this information with them, you may help prevent possible interactions.

Imitrex may interact with tryptophan supplements. They’re often taken to help with anxiety and difficulty falling asleep.

Tryptophan can raise the levels of a chemical in your body called serotonin. Imitrex can also increase serotonin levels. If you take tryptophan with Imitrex, the levels of serotonin could rise further. If serotonin levels become very high, you could develop a rare but serious side effect called serotonin syndrome. In certain cases, this can be life threatening.

Due to this risk, your doctor may recommend that you do not take tryptophan during Imitrex treatment. They can suggest an alternative.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Imitrex interactions with herbs

It’s possible for Imitrex to interact with certain herbs, such as St. John’s wort. This herb is often taken to help with depression.

St. John’s wort can increase the levels of a chemical in your body called serotonin. Imitrex can also increase serotonin levels. If you take St. John’s wort with Imitrex, the levels of serotonin could rise further. If serotonin levels become very high, you could develop a rare but serious side effect called serotonin syndrome. In certain cases, this can be life threatening.

Due to this risk, your doctor may recommend that you do not take St. John’s wort during Imitrex treatment. They can suggest an alternative.

Imitrex and vitamins

There have been no specific reports of vitamins interacting with Imitrex. However, it’s possible that interactions with vitamins could be recognized in the future. Because of this, you should talk with your doctor or pharmacist before taking any vitamin product with Imitrex.

Imitrex and food

No food interactions have been reported with Imitrex. If you’d like to learn more about eating certain foods during treatment with Imitrex, talk with your doctor.

Imitrex and vaccines

There aren’t any known interactions between Imitrex and vaccines. To find out what vaccines you may need, talk with your doctor or pharmacist.

Imitrex and lab tests

Imitrex is not known to interact with any lab tests. If you have any questions, you can talk with your doctor.

IMITREX AND CANNABIS OR CBD

Cannabis (often called marijuana) and cannabis products, such as cannabidiol (CBD), have not been specifically reported to interact with Imitrex. However, as with any drug or supplement, talk with your doctor before using cannabis in combination with Imitrex. The impact of cannabis may affect how well you stick to your Imitrex treatment plan.

Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.

Certain medical conditions and other factors may increase the risk of interactions with Imitrex. Before you take this drug, be sure to talk with your doctor about your health history. Imitrex may not be the right treatment option if you have certain medical conditions or other factors affecting your health.

Health conditions or factors that might interact with Imitrex include:

• Heart disease. Tell your doctor if you have heart disease, such as coronary artery disease or coronary artery vasospasm, before taking Imitrex.*
• Electrical problem in your heart. If you have an electrical problem in your heart, such as Wolff-Parkinson-White syndrome, talk with your doctor before taking Imitrex.*
• History of stroke or ministroke. If you have ever had a stroke or transient ischemic attack (TIA), which is also called a ministroke, tell your doctor before taking Imitrex.*
• Unmanaged blood pressure. If you have high blood pressure that’s not well managed, talk with your doctor before taking Imitrex. To learn more, see “When to avoid Imitrex” above.
• Hemiplegic or basilar migraine. If you have certain types of migraine, called hemiplegic or basilar migraine, tell your doctor before taking Imitrex.*
• Severe liver disease. Tell your doctor about any liver problems you have before taking Imitrex.*
• Peripheral vascular disease. Before taking Imitrex, tell your doctor if you have peripheral vascular disease.*
• Ischemic bowel disease. If you have ischemic bowel disease, tell your doctor before taking Imitrex.*
• Allergic reaction. If you’ve had an allergic reaction to Imitrex or any of its ingredients, your doctor will likely not prescribe Imitrex.*
• Seizures. It’s possible for Imitrex to increase your risk of seizures, but this is very rare. If you have a seizure disorder such as epilepsy or a history of seizures, your doctor may monitor you more often during your Imitrex treatment. In some cases, they may recommend a different drug.
• Risk factors for heart disease. Imitrex can increase your risk of a heart problem. If you already have risk factors for heart disease, taking Imitrex may increase your risk further. These risk factors may include high cholesterol, smoking, obesity, and diabetes. Your doctor may monitor you more often or check your heart before you take Imitrex. In some situations, they may recommend a different treatment.
• Pregnancy. It’s not known whether Imitrex is safe to take during pregnancy. If you’re pregnant or planning to become pregnant, talk with your doctor before taking Imitrex. You can also find more information about Imitrex and pregnancy here.
• Breastfeeding. Imitrex passes into breast milk, so a breastfed child will be exposed to the drug. At this time,it’s not known what effects Imitrex may have on a breastfed child. If you’re breastfeeding or thinking about it, talk with your doctor before taking Imitrex. You can also learn more about Imitrex and breastfeeding here.

* To learn more, see “When to avoid Imitrex” above.

Here are some frequently asked questions about Imitrex and possible interactions.

Are there any interactions between Imitrex and over-the-counter pain medications?

No, there aren’t any known interactions between Imitrex and over-the-counter (OTC) pain medications, such as:

• ibuprofen (Advil, Motrin)
• naproxen (Aleve)
• acetaminophen (Tylenol)

It’s usually safe to take Imitrex in combination with OTC pain medications.

However, it’s important to note that prescription pain medications, such as tramadol (ConZip), may interact with Imitrex. For details, see “Other serotonergic drugs” in “Drug interactions in depth” above.

If you have additional questions about taking OTC pain relievers during Imitrex treatment, talk with your doctor or pharmacist.

Can I take Sudafed along with Imitrex?

It’s probably safe to take Imitrex with pseudoephedrine (Sudafed). There aren’t any reported interactions between these two drugs. Sudafed is used to help ease sinus and nasal congestion.

However, it’s important to note that both Sudafed and Imitrex can increase your blood pressure. Although this is not listed as an interaction, if you already have high blood pressure, taking these medications together may increase it further.

If you’re interested in taking Sudafed during Imitrex treatment, first talk with your doctor. They can help determine whether the combination is safe for you.

You can take certain steps to help prevent interactions with Imitrex. Your doctor and pharmacist are key resources, so reach out to them before starting treatment. For example, you should plan to do the following:

• Let them know if you drink alcohol or use cannabis.
• Tell them about any other medications you take, as well as any supplements, herbs, and vitamins.
• Create a medication list, which your doctor and pharmacist can help you fill out.

It’s also important to read the Imitrex label and other paperwork that may come with the drug. The label may have colored stickers that mention an interaction. And the paperwork, sometimes called the medication guide or patient package insert, may contain details about interactions. (If Imitrex doesn’t come with paperwork, you can ask your pharmacist to print a copy.) If you have questions about this information, ask your doctor or pharmacist.

You can also help prevent interactions with Imitrex by taking it exactly as your doctor prescribes.

Besides learning about interactions, you may want to find out more about Imitrex. These resources might help:

• Overview of Imitrex. For a general overview of Imitrex, you can see this article.
• Side effects. If you’re interested in the side effects of Imitrex, see this article. Another option is to refer to the Imitrex prescribing information for the injection, tablets, or nasal spray.
• Dosage specifics. To learn about the dosage of Imitrex, see this article.
• Drug comparison. Learn how Imitrex compares with Maxalt and Relpax.
• Facts about migraine. To find out more about your condition, see our headache and migraine hub.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.