Reactions 1270 - 19 Sep 2009

SNaratriptan

Acute coronary syndrome in an elderly patient:case report

A 67-year-old woman developed acute coronarysyndrome during treatment with naratriptan for migraines.

The woman had a 45-year history of migraines, whichhad been controlled with naratriptan (as-needed) for thelast 5 years. She developed a migraine attack one evening,and took her usual oral dose of naratriptan 2.5mg. Herheadaches improved, but she developed thoracic pain30–60 minutes later. Chest pain progressively worsenedduring the night and began radiating to her neck; shepresented to her family doctor the following morning. AnECG revealed T-wave inversions in the first four precordialleads, and a troponin test was positive. Acute coronarysyndrome was diagnosed and she was referred to hospital.On admission, T-wave inversions in V1–V4 persisted; hercreatine kinase and troponin-T levels increased to maximaof 518 U/L and 0.42 µg/L, respectively.

The woman received aspirin, clopidogrel, heparin,oxygen and nitrates. Her coronary arteries appeared patenton coronary angiography, and her left ventricular ejectionfraction was normal. Naratriptan was discontinued, and shebegan receiving amlodipine. She was in good condition ondischarge after 4 days. Two years later, her cardiac statushad remained stable and her migraines had resolved.

Author comment: "We postulated transient, prolongedcoronary vasospasm caused by the vasoconstrictor propertiesof [naratriptan] as the pathophysiological mechanism for theacute coronary syndrome in this patient without underlyingcoronary heart disease."Weder CR, et al. Triptans and troponin: a case report Orphanet Journal of RareDiseases 4: [3 pages], No. 15, 18 Jun 2009 - Switzerland 801150751

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Reactions 19 Sep 2009 No. 12700114-9954/10/1270-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved