Eletriptan (Relpax) Risks, Warnings, and Complications

CARDIOVASCULAR RISKS: Eletriptan can cause heart problems in some people. This can occur within a few hours of taking a dose and may include angina (chest pain), heart rhythm abnormalities, and heart attack. Eletriptan can also raise your blood pressure to dangerously high levels. Talk to your doctor about the benefits versus risks of taking eletriptan if you have pre-existing heart or blood vessel problems. 

Your doctor will perform a cardiovascular evaluation if you are taking triptan drugs for the first time and have multiple cardiovascular risk factors such as age, obesity, diabetes, hypertension, smoking, and a family history of coronary artery disease. 

You will not be prescribed eletriptan if you have uncontrolled hypertension (high blood pressure), coronary heart disease, coronary artery vasospasm, or Prinzmetal's variant angina. This medicine is also contraindicated in people with Wolff-Parkinson-White syndrome or other arrhythmias (heart rhythm abnormalities) associated with accessory conduction pathways.

If you are deemed to be a candidate for eletriptan therapy based on a negative cardiovascular evaluation, your doctor may recommend taking the first dose in a healthcare setting so you can be monitored for serious adverse effects. They may order an electrocardiogram (ECG) immediately after you take eletriptan. You may be advised to undergo a cardiovascular evaluation periodically if you are going to take this migraine medicine long-term.

Note: It is common to experience jaw, throat, neck, and chest pain, tightness, or pressure after taking eletriptan. This is usually non-cardiac in origin. However, you should undergo an evaluation to rule out cardiac causes if you experience these symptoms.

CEREBROVASCULAR RISKS: Some people who took 5-HT1 agonists, including eletriptan, have had life-threatening and fatal strokes and brain bleeds. It is possible that these cerebrovascular events were occurring and a 5-HT1 agonist such as eletriptan was taken by the person under the mistaken belief that the symptoms were caused by migraine, whereas in reality, they were not. 

Your healthcare provider will rule out other serious neurological conditions before treating headaches with eletriptan, especially if you don’t have a confirmed diagnosis of migraine or if your symptoms are atypical for migraine. People with a history of stroke or TIA (transient ischemic attack or mini-stroke) should not take eletriptan. 

Seek emergency medical care if you develop sudden numbness or weakness on one side of the body, trouble speaking, trouble walking, severe headache, confusion, or vision problems.

VASOSPASM (NARROWING OF BLOOD VESSELS): Eletriptan can cause vasospastic reactions (narrowing of blood vessels) in many parts of the body besides the heart. This can result in a range of symptoms due to reduced blood flow, including severe stomach pain, bloody diarrhea, vision changes, pale or blue fingers or toes, abnormal sensations in the hands and feet, and other symptoms. Tell your doctor if you develop any unusual symptoms. Do not take additional doses of eletriptan until your doctor has evaluated you. 

MEDICATION OVERUSE HEADACHES: Taking anti-migraine medications such as triptans, ergotamine, opioids, or combination drugs on 10 or more days per month can lead to worsening headaches. This is called a medication overuse headache. It can be a daily migraine-like headache or an increased frequency of migraine attacks. 

You will need to undergo detoxification through withdrawal of the overused migraine drugs if you develop medication overuse headaches. You may experience withdrawal symptoms, such as a temporary increase in headache severity and frequency while you are detoxing.

SEROTONIN SYNDROME: Serotonin is a neurotransmitter (natural chemical) in the brain. Serotonin syndrome is a serious condition that occurs when there is too much serotonin in the body. This condition can occur with eletriptan, especially if you are also taking certain medications that can also increase serotonin levels, for example, selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), and monoamine oxidase (MAO) inhibitors.

Symptoms of serotonin syndrome may include autonomic instability (fast heart rate, high or low blood pressure, elevated body temperature); changes in mental status (agitation, hallucinations, loss of consciousness); neuromuscular abnormalities (lack of coordination, overactive reflexes, muscle stiffness); and/or gastrointestinal symptoms (nausea, vomiting, diarrhea). 

Serotonin syndrome symptoms can occur within minutes to hours of taking a new or higher dose of a serotonergic drug. Stop taking eletriptan and seek emergency medical treatment if you develop any of these symptoms.

SERIOUS ALLERGIC REACTIONS: Very rarely, eletriptan can cause serious and potentially fatal hypersensitivity reactions including anaphylaxis (throat closing) and angioedema (swelling), leading to difficulty breathing. Tell your doctor if you have a history of multiple allergies. Seek emergency medical attention if you develop swelling, throat closing, or trouble breathing.