DULOXETINE-ASSOCIATED TACHYCARDIA
Stevens DL
The Annals of Pharmacotherapy 2008; 42:1511-1513


RIASSUNTO
Viene riportato il caso di un uomo, in terapia con l'antidepressivo duloxetina 20 mg/die da 2 mesi per disordini distimici, che ha sviluppato tachicardia, fatica, diaforesi e dolore toracico, risoltisi con l'interruzione del farmaco e il trattamento con propranololo. Il rechallange positivo ha confermato l'associazione farmaco-evento. I clinici dovrebbero essere al corrente circa la possibilità di insorgenza di tachicardia clinicamente significativa in pazienti che assumono duloxetina, anche a base dosi.

CASE REPORT
OBJECTIVE: To report a case of symptomatic tachycardia that was successfully treated with propranolol in a patient receiving duloxetine.
CASE SUMMARY: A 26-year-old man presented with episodes of fatigue, tachycardia, diaphoresis, and chest pain approximately 2 months after the initiation of duloxetine 20 mg/day for dysthymic disorder. Cardiac workup including echocardiogram, exercise treadmill testing, and Holter monitoring was negative, except for tachycardia (heart rate 110-120 beats/min). Duloxetine was withheld, and the patient's heart rate returned to normal in less than a week. Duloxetine was restarted at the same dosage, and tachycardia returned within 2 days. Propranolol was added to the treatment regimen to lower the heart rate. Because of therapeutic failure of other antidepressants, duloxetine was continued because of its beneficial effects on mood.
DISCUSSION: One published case report describing tachycardia in association with duloxetine in 2 heart failure patients was found in a MEDLINE search (1966-July 2008). Increased blood pressure and heart rate have been reported in duloxetine trials. The proposed mechanism for duloxetine-induced tachycardia is its effects on norepinephrine, which impact the cardiovascular system. Use of the Naranjo probability scale indicated duloxetine as a probable cause of this patient's tachycardia.
CONCLUSIONS: Clinicians should be aware of the possibility of clinically significant tachycardia in patients receiving duloxetine, even in low doses.