Despite this limitation, a consistent finding emerged. In the majority of the cases, the symptoms of ischemic colitis followed a reasonable temporal sequence after only a few doses of sumatriptan and resolved after discontinuation of the treatment. Even though concomitant drug therapies complicate the analysis, the patients had been exposed to these other therapies for an extended period, with no evidence of the symptoms noted shortly after the exposure to sumatriptan, as illustrated in case 2. The symptoms resolved after discontinuation of sumatriptan therapy and despite continued fluoxetine use. The possibility that the ischemic event involved a drug interaction or an additive effect between sumatriptan and the concurrent medications used by the patients cannot be definitely excluded, except in case 1.
Sumatriptan use is widespread, yet reports of ischemic colitis are rare.
The 2 case reports detailed herein provide possible answers. Both women had histories of bowel disease and laparoscopic procedures. An underlying subclinical colonic disease acted on by other factors may have contributed to accentuating the vulnerability of these particular patients. Sumatriptan use could exacerbate a previously quiescent inflammatory bowel disease. Both women had a history of cigarette smoking, a known risk in the development of diffuse small vessel disease.