From the Guidelines
The patient should not use Elavil (amitriptyline) for migraines due to potential serious drug interactions with her current medications, Celexa (citalopram) and trazodone, which can lead to serotonin syndrome and QT interval prolongation. According to the most recent and highest quality study, 1, there are better alternatives for migraine prevention that do not interact with her current medications. For example, the study recommends candesartan or telmisartan for the prevention of episodic migraine, and erenumab, fremanezumab, or galcanezumab for the prevention of episodic or chronic migraine.
Some key points to consider:
- The patient's current medications, Celexa and trazodone, increase serotonin levels in the brain, and adding Elavil can lead to excessive serotonin accumulation and increase the risk of serotonin syndrome.
- The combination of these medications may also increase the risk of QT interval prolongation, which can cause dangerous heart rhythm problems.
- The study 1 suggests topiramate, propranolol, or Botox injections as alternative options for migraine prevention that do not interact with her current medications.
- For acute migraine treatment, triptans or NSAIDs might be appropriate, though triptans should be used cautiously with Celexa, as recommended in the study 1.
It is essential for the patient to discuss these alternative options with her healthcare provider rather than adding Elavil to her current medication regimen. The patient's healthcare provider can help determine the best course of treatment for her migraines, taking into account her current medications and medical history.
From the Research
Migraine Treatment and Celexa and Trazodone
- The patient is currently taking Celexa and Trazodone for migraines, and the question is whether they can use Elevil for migraines.
- Elevil is another name for amitriptyline, a tricyclic antidepressant that has been shown to be effective in preventing migraines 2, 3, 4.
- Studies have demonstrated that amitriptyline is a popular medication with established effectiveness and manageable levels of negative side effects for migraine prevention 2.
- In one study, amitriptyline was found to be more effective than propranolol in reducing the frequency, duration, and severity of migraine episodes 2.
- Another study found that amitriptyline and topiramate combination may be beneficial for patients with migraine and comorbid depression, particularly in terms of side effects and associated displeasure due to monotherapy 5.
Potential Interactions and Considerations
- The patient is already taking Celexa (an SSRI) and Trazodone (an antidepressant), and adding amitriptyline (Elevil) to their regimen may increase the risk of side effects or interactions 6, 4.
- The decision to use amitriptyline for migraine prevention should be made after considering the potential benefits and risks, as well as alternative treatment options 3, 6.
- It is essential to consult with a healthcare professional to discuss the potential interactions and considerations before starting amitriptyline for migraine prevention.