Abstract
Sir Welch et al.'s careful review of the extensive post-marketing data on sumatriptan (1) shows that this drug is generally well tolerated, with an acceptable benefit–risk ratio when used in accordance with the prescribing information. As noted by the authors, sumatriptan and other triptans should not be given to patients with, or at high risk for, coronary or cerebrovascular disease.
An important safety issue that was not discussed in the article is that data have recently been presented which might be misinterpreted by those not expert in the field as showing that some triptans may have improved cardiovascular safety. These include the use of cranial-coronary contraction ratios from isolated vessel preparations (2), ECG studies in patients at risk of or with frank coronary artery disease that show negative results (3), or citing lower incidence of chest symptoms seen in clinical studies (4). We are concerned that the general medical community might perceive these data as implying a cardiovascular safety benefit for one triptan over another. We would like to emphasize to your readers that all triptans are contraindicated in patients with coronary artery disease and it would be very unwise at this point to conclude that one triptan is safer than another. Also, given the typical patient population with migraine, focusing on the perception of cardiovascular safety for the triptan class only serves as a distraction from the real work at hand, which includes effective recognition of migraine and appropriate management strategies.