<div>Table1. Laboratory findings at admitted time</div><div><b>Discussion </b></div><div>Sumatriptan, a potent drug with a vasoconstriction effect prescribed in
the treatment of migraine attacks; can cause minor complications,
including sweating, transient hypertension, tachycardia, behavioral
changes, fatigue, sleepiness, and skin reaction (5). Similarly, our case
presented with a significant rise in blood pressure level and heart
rate. Moreover, agitation and hallucination were seen in this patient.
On the other hand, despite injecting 30 vials of sumatriptan, no
reaction at the injection site was detected. Persistent to our study,
Owen et al. demonstrated tachycardia induced by sumatriptan in animals
as well (3). Some of these complications are related to serotonin
syndrome, a drug-induced syndrome associated with sumatriptan
administration (8).</div><div>This effective drug has major adverse effects such as hepatotoxicity by
causing oxidative stress in hepatocytes (6). Besides, an increased level
of liver enzymes was identified in this patient that which is a sign of
affecting the liver.</div><div>Additionally, urine and fecal incontinency were realized in this case.
Another study on rabbits proved that drugs that act on 5-HT1 receptors
have regulatory action on bladder activity (9). On the other hand, there
is no available data about this pivotal effect on humans.</div><div>Increased creatinine level was detected in this case that, previously
proved by Mobasheran et al. In 2019, they performed a trial on rats that
revealed the administration of sumatriptan induces renal injury by
activating nitric oxide synthase and oxidative responses (7). In
addition, bilateral renal infarction, a rare side effect, was recognized
in a healthy 45-year-old woman after prescribing sumatriptan (10).
Additionally, Sharma et al. reported renal cortical infarction induced
by sumatriptan in a kidney allograft recipient (11). On the other hand,
Sheibani et al. displayed that the prescription of low doses of
sumatriptan in male rats has protective effects on renal injury because
of its anti-inflammatory agents (12).</div><div>Previously, Kelly displayed that one dose of sumatriptan can cause
sudden cardiac arrest because of coronary artery vasoconstriction (13).
Despite positive troponin, and increased level of LDH and CPK, there was
no positive clue about myocardial infarction in our patient according to
the biopsy.</div><div><b>Conclusion</b></div><div>Sumatriptan, that is used to treat migraine episodes, can affect many
systems in healthy humans, including cardiovascular system, causing
myocardial infarction (14). There are some studies about the toxicity of
this drug just in animals (3). Our case supports the novel complications
of sumatriptan toxicity in humans, including urine incontinency,
nephritic syndrome, and hepatotoxicity. Further clinical trials are
required to reveal the complications of the sumatriptan, especially in
patients with positive past medical history.</div>