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Jan Paul Ottervanger, MD, PhD; Hans A. Valkenburg, MD, PhD; Diederick E. Grobbee, MD, PhD; Bruno H. C. Stricker, MB, PhD

Arch Neurol. 1997;54(11):1387-1392.

Abstract
Background
Serious cardiac adverse reactions, including myocardial infarction, have been attributed to the antimigraine drug sumatriptan succinate. Chest pain is considered to be a relatively common adverse reaction to sumatriptan.

Design
Postmarketing study.

Patients and Methods
The study was a part of a national cohort study on adverse reactions to sumatriptan, which was performed with the assistance of drug-dispensing general practitioners in the Netherlands. After data were collected on observed adverse reactions, the patients received a second questionnaire, with specific questions regarding the adverse event, and questions regarding medical history, other health complaints, and smoking habits. Furthermore, they had a physical examination and a blood cholesterol measurement.

Results
A total of 137 patients with chest pain associated with intake of sumatriptan were identified and compared with 229 consumers of sumatriptan without this adverse reaction. After multivariate analysis, young age, hypertension, general complaints of abdominal pain, and a family history of myocardial infarction were associated with an increased risk of chest pain attributed to sumatriptan. Hypertension in particular was a risk factor for sumatriptan-induced chest pain in men (relative risk, 8.0; 95% confidence interval, 1.8-40) compared with hypertension as a risk factor in women (relative risk, 1.63; 95% confidence interval, 0.9-3.1).

Conclusions
Young age, hypertension, general complaints of abdominal pain, and a family history of myocardial infarction are associated with an increased risk of chest pain attributed to sumatriptan. Sex is an effective modifier of risk factors of sumatriptan-induced chest pain. In particular, hypertension is a strong risk factor in men.

Author Affiliations
From the Netherlands Centre for Monitoring of Adverse Reactions to Drugs, Rijswijk (Drs Ottervanger and Stricker); Department of Internal Medicine II, University Hospital Dijkzigt, Rotterdam, the Netherlands (Dr Ottervanger); Department of Epidemiology and Biostatistics, Erasmus University Medical School, Rotterdam (Drs Valkenburg, Grobbee, and Stricker); and Julius Center for Patient-oriented Research, Utrecht University Medical School, Utrecht, the Netherlands (Dr Grobbee).

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