Imitrex Warnings and Precautions (Cont.)

• Imitrex can interact with certain other medications (see Imitrex Drug Interactions).
   
• Imitrex has been reported to increase the risk of a heart attack or a life-threatening change in a person's heart rhythm (arrhythmia). You should not take Imitrex if you have heart disease or a history of a heart attack, stroke, or transient ischemic attack (TIA or "mini-stroke") (see Imitrex and Heart Problems for more information).

If you have risk factors for heart disease (see Heart Disease Risk Factors), it is also strongly recommended that you take your first dose of Imitrex in your healthcare provider's office. This is so your healthcare provider can monitor your heart.

• In some cases, a stroke or transient ischemic attack can be misdiagnosed as a migraine. Before prescribing Imitrex, your healthcare provider should make sure you are not having a stroke, especially if you have never had migraines in the past (see Stroke Symptoms for more information on the symptoms of a stroke).
   
• Imitrex can cause blood vessels in the arms, legs, colon (large intestine), and other locations to spasm. This can cause a decrease in blood flow to these areas. Symptoms will vary based on the location. For example, a spasm in the colon can lead to severe abdominal pain (or stomach pain) or bloody diarrhea.
   
• Taking Imitrex with certain antidepressants, including selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs), can increase your risk of a dangerous group of symptoms called serotonin syndrome. Do not use Imitrex with antidepressants without first discussing it with your healthcare provider. Contact your healthcare provider immediately if you have any possible symptoms of serotonin syndrome, including:

o Confusion

o Seeing or hearing things that are not really there (hallucinations)

o Fast heartbeat (tachycardia)

o Feeling faint

o Fever

o Sweating

o Muscle spasms

o Difficulty walking

o Diarrhea.

• Due to the possibility of a dangerous reaction, Imitrex Injection should not be given into a vein (which is known as giving it intravenously). Imitrex Injection should be given just below the skin (this is known as giving it subcutaneously).
   
• Imitrex can cause an increase in blood pressure. You should not take Imitrex if you have untreated high blood pressure (hypertension).
   
• Taking Imitrex with MAO inhibitors -- such as phenelzine (Nardil^®), tranylcypromine (Parnate^®), and isocarboxazid (Marplan^®) -- can cause dangerously high levels of Imitrex in the blood. You should not take Imitrex if you have taken an MAO inhibitor within the past two weeks.
   
• Imitrex is considered a pregnancy Category C medication. This means that Imitrex may not be safe for use during pregnancy. Talk with your healthcare provider before using Imitrex if you are pregnant (see Is Imitrex Safe During Pregnancy? for more information).
   
• Imitrex passes through breast milk. Therefore, if you are breastfeeding or plan to start breastfeeding, be sure to talk with your healthcare provider about this.
   
• If you have chest pain or jaw or neck tightness after taking Imitrex, contact your healthcare provider immediately. These side effects are fairly common with Imitrex and are not usually serious. However, your healthcare provider may need to make sure you are not having heart problems.
   
• Tell your healthcare provider if you have liver problems (including liver failure or cirrhosis) or kidney problems (including kidney failure) before taking Imitrex. This is important because Imitrex is removed from the body through the liver and kidneys.
   
• There have been rare cases of seizures in people taking Imitrex. If you have a history of seizures, talk with your healthcare provider before starting Imitrex.
   
• Imitrex may cause changes in the eyes or vision problems. Tell your healthcare provider if you have eye or vision changes during treatment with Imitrex.