Pharmacology IV – Headache Therapeutics Practice Test

Concomitant use of ergot derivatives with triptans is contraindicated because of the risk of what?

There is no risk when combined with triptans. Increased risk of vasospasm. Safe use in pregnancy. It reduces the efficacy of triptans.

Correct Answer:

Increased risk of vasospasm.

Explanation:

The risk being tested is the potential for dangerous vasospasm from combining two drugs that both constrict blood vessels through serotonin receptor activity. Triptans activate 5-HT1B/1D receptors on cranial vessels, causing vasoconstriction and reducing CGRP-mediated pain signaling. Ergot derivatives are nonspecific serotonergic agents (and also interact with other receptors) that produce strong vasoconstriction. When used together, their effects can sum to excessive constriction of cerebral and peripheral arteries, increasing the chance of ischemia or infarction in the brain, heart, or extremities. That’s why this combination is contraindicated. It isn’t a matter of safety in pregnancy, nor does it reduce efficacy of triptans; there is a real added risk of vasospasm.

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