Reactions 1308 - 3 Jul 2010

SNaratriptan

Ischaemic colitis: case reportA 60-year-old woman developed ischaemic colitis during

treatment with naratriptan for migraine [all dosages andduration of treatment to reaction onset not stated].

The woman, who had a history of migraine-associatedheadache for which naratriptan was prescribed and takenfrequently on demand, presented with sudden-onsetabdominal pain and haematochezia 1 day prior toadmission. She reported severe lower abdominal pain andfrequent bloody diarrhoea and nausea. Her pharmacistreported that she had received 12 naratriptan 2.5mg tabletsevery 6 weeks with a maximum of naratriptan 5.0 mg/day.Three days earlier and 8 hours after symptom onset, shehad taken naratriptan 5.0mg. Physical examinationrevealed mild distress because of abdominal discomfort.She had a temperature of 37.6°C and left lower-quadranttenderness. Digital rectal examination revealed rectal bloodloss. On hospital day 1, colonoscopy demonstrated severesubmucosal oedema and mucosal ulcers in her descendingcolon, which extended to at least 15cm in her sigmoidcolon; findings were consistent with the blood supply ofthe inferior mesenteric artery. Her colonoscopy wasprematurely terminated due to increased risk ofperforation. Colonic biopsy findings were compatible withischaemic colitis. Circumferential thickening of thedescending colon was demonstrated by CT scans andangiography.

Naratriptan was discontinued and the woman receivedIV hydration. Her condition recovered and she wasdischarged 4 days after admission. However, herabdominal complaints persisted, but endoscopy did notreveal ischaemia. Findings from a repeat CT scan wereunremarkable. After 2 months, her complaints hadcompletely resolved.

Author comment: "When [the Naranjo probability scalewas] applied in this case, a score of 8 indicates a probablelikelihood of naratriptan as the cause for ischemic colitis."Westgeest HM, et al. Pure naratriptan-induced ischemic colitis: A case report.Turkish Journal of Gastroenterology 21: 42-44, No. 1, Mar 2010. Available from:URL: http://dx.doi.org/10.4318/tjg.2010.0047 - Netherlands 803022401

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Reactions 3 Jul 2010 No. 13080114-9954/10/1308-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved