Reactions 1029 - 27 Nov 2004

SNaratriptan

Ischaemic colitis: case reportA 54-year-old woman developed ischaemic colitis during

treatment with naratriptan for migraine headache.The woman, who had a past history of irritable bowel

syndrome, reported that bloody diarrhoea and severe crampylower abdominal discomfort had started abruptly about24 hours prior to presentation. She reported that she hadexperienced 15–20 episodes of haematochezia, and that frankblood clots had been passed immediately prior topresentation. She had taken oral naratriptan 2.5mg as neededfor a few months, and had received about three doses in thepast week. Concomitant medications included gabapentin,topiramate, quetiapine, zolpidem and lansoprazole. Grossblood without perianal disease was observed on rectalexamination. Laboratory examination showed a WBC count of15 600 cells/mm3, an haematocrit of 37.7%, and a Westergrensedimentation rate of 35 mm/h (normal ≤ 30 mm/h). Anabdominal CT scan revealed that the distal transverse anddescending colon had severe circumferential thickening.Colonoscopy showed haemorrhagic colitis involving thesplenic flexure. Focal ulcerations were also seen. Biopsyfindings were consistent with ischaemic colitis.

The woman received supportive care and improved rapidly.She was discharged on hospital day 4 and, 6 months later, shehad no diarrhoea or overt GI haemorrhage.

Author comment: "A link between naratriptan use and thedevelopment of ischaemic colitis has been suggestedpreviously by French investigators who reported on a singlecase."*

* See Reactions 953: 12, 31 May 2003; 800923312

Schwartz DC, et al. Colonic ischemia associated with naratriptan use. Journal ofClinical Gastroenterology 38: 790-792, No. 9, Oct 2004 - USA 800983446

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Reactions 27 Nov 2004 No. 10290114-9954/10/1029-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved