Table1. Laboratory findings at admitted time
Discussion
Sumatriptan, a potent drug with a vasoconstriction effect prescribed in the treatment of migraine attacks; can cause minor complications, including sweating, transient hypertension, tachycardia, behavioral changes, fatigue, sleepiness, and skin reaction (5). Similarly, our case presented with a significant rise in blood pressure level and heart rate. Moreover, agitation and hallucination were seen in this patient. On the other hand, despite injecting 30 vials of sumatriptan, no reaction at the injection site was detected. Persistent to our study, Owen et al. demonstrated tachycardia induced by sumatriptan in animals as well (3). Some of these complications are related to serotonin syndrome, a drug-induced syndrome associated with sumatriptan administration (8).
This effective drug has major adverse effects such as hepatotoxicity by causing oxidative stress in hepatocytes (6). Besides, an increased level of liver enzymes was identified in this patient that which is a sign of affecting the liver.
Additionally, urine and fecal incontinency were realized in this case. Another study on rabbits proved that drugs that act on 5-HT1 receptors have regulatory action on bladder activity (9). On the other hand, there is no available data about this pivotal effect on humans.
Increased creatinine level was detected in this case that, previously proved by Mobasheran et al. In 2019, they performed a trial on rats that revealed the administration of sumatriptan induces renal injury by activating nitric oxide synthase and oxidative responses (7). In addition, bilateral renal infarction, a rare side effect, was recognized in a healthy 45-year-old woman after prescribing sumatriptan (10). Additionally, Sharma et al. reported renal cortical infarction induced by sumatriptan in a kidney allograft recipient (11). On the other hand, Sheibani et al. displayed that the prescription of low doses of sumatriptan in male rats has protective effects on renal injury because of its anti-inflammatory agents (12).
Previously, Kelly displayed that one dose of sumatriptan can cause sudden cardiac arrest because of coronary artery vasoconstriction (13). Despite positive troponin, and increased level of LDH and CPK, there was no positive clue about myocardial infarction in our patient according to the biopsy.
Conclusion
Sumatriptan, that is used to treat migraine episodes, can affect many systems in healthy humans, including cardiovascular system, causing myocardial infarction (14). There are some studies about the toxicity of this drug just in animals (3). Our case supports the novel complications of sumatriptan toxicity in humans, including urine incontinency, nephritic syndrome, and hepatotoxicity. Further clinical trials are required to reveal the complications of the sumatriptan, especially in patients with positive past medical history.