Which of the following are contraindications to sumatriptan?

• A. Hypertension
• B. CAD
• C. Stroke
• D. Hypertension, CAD, and stroke

Answer: (D)

Sumatriptan’s safety hinges on avoiding vasoconstriction of blood vessels in patients with vascular disease. It works by activating 5-HT1B/1D receptors to constrict cranial arteries, which can relieve migraine, but this same vasoconstrictive action can reduce blood flow in other critical vessels. In people with cardiovascular disease, a history of stroke, or uncontrolled hypertension, constriction of coronary or cerebral vessels can precipitate myocardial ischemia, arrhythmias, or cerebral ischemia. Because all three conditions—hypertension, CAD, and prior stroke—pose significant risk with sumatriptan, they are all considered contraindications. The option that includes all three reflects the full scope of when the drug should be avoided.