Q. I have suffered with both migraines and depression for years. My doctor prescribed Cymbalta for the depression, sumatriptan for the migraines, Provigil to stay awake during the day and trazodone to sleep at night.
I am experiencing strong heart palpitations, horrible nightmares, muscle spasms, restlessness and insomnia. Could my medicines be causing these symptoms?
A. You are taking three medicines that can interact in a very dangerous way. Duloxetine (Cymbalta), sumatriptan (Imitrex) and trazodone (Desyrel) can trigger a reaction called serotonin syndrome. Symptoms may include agitation, muscle spasms, palpitations, confusion, overactive reflexes and tremor.
We are dismayed that neither your doctor nor your pharmacist spotted this potentially life-threatening combination. Unfortunately, computerized warnings of such hazardous interactions may be ignored or overridden.
You can learn more about serotonin syndrome and other dangerous drug interactions in our book, Top Screwups Doctors Make and How to Avoid Them.
Please contact your doctor promptly to develop a strategy for modifying this regimen. You should be able to treat your depression and your migraines without risking your life.
