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The Journal of the American Board of Family Medicine 23 (1): 124-127 (2010)
DOI: 10.3122/jabfm.2010.01.090086
© 2010 American Board of Family Medicine
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Brief Report

Ischemic Colitis Related to Sumatriptan Overuse

MAJ Joshua A. Hodge, MD, USAF, MC and Katherine D. Hodge, CPNP, MSN

From the National Capital Consortium-Dewitt Army Community Hospital, Family Medicine Residency (JAH), Ft. Belvoir, VA

Correspondence: Corresponding author: MAJ Joshua A. Hodge, MD, USAF, MC, National Capital Consortium-Dewitt Army Community Hospital, Family Medicine Residency, 9501 Farrell Road, Ft. Belvoir, VA 22060 (E-mail: joshua.hodge{at}amedd.army.mil)

Background: Serotonin-1 5-hydroxytryptamine (5-HT 1) receptor agonists are first line agents for migraine headaches. Patients with refractory headaches may use supratherapeutic doses of these medications. Described is a case of ischemic colitis related to overuse of sumatriptan.

Case: A 35-year-old woman presented with severe abdominal pain without diarrhea or hematochezia. For several days prior she had been self-treating a refractory migraine headache with frequent doses of sumatriptan. She is a nonsmoker and took no oral contraceptives or other serotonin agonists. A computed tomography scan of the abdomen revealed left-sided colitis. A colonoscopy with biopsy confirmed ischemic colitis and excluded inflammatory bowel disease (IBD).

Discussion: Previously published case reports have suggested an association between 5-HT 1 receptor agonists and ischemic colitis. These reports have been dismissed because the patients were taking oral contraceptives, serotonin agonists, or had other comorbidities. This healthy patient lacked risk factors for ischemia, is the youngest to be reported, and is the first without hematochezia.

Conclusion: 5-HT 1 receptor agonists are generally considered safe. Ischemic colitis is a potentially serious complication of these agents. A retrospective review of 5-HT 1 receptor agonist users who have presented with acute onset abdominal pain or hematochezia is necessary to elucidate the incidence of this adverse event.


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