Reactions 1075 - 29 Oct 2005

SAmitriptyline/cisapride

Fatal cardiomyopathy in a child: case reportA 6-year-old girl with recessive dystrophic epidermolysis

bullosa developed fatal cardiomyopathy during treatment withamitriptyline for chronic pain and cisapride for chronic gastro-oesophageal reflux.

The girl received amitriptyline therapy sporadically beforethe age of 4 years. When she was aged 4 years and 10 months,amitriptyline was restarted at a dosage of 6mg at night,increased to 3.4mg twice daily at the age of 5 years and2 months, to 3.4mg in the morning and 7mg at night at the ageof 5 years and 5 months, and to 8mg twice daily at the age of5 years and 7 months. From the age of 4 years and 8 months,she received cisapride; the highest dosage was 2.2mg twicedaily. At the age of 5 years and 10 months, anechocardiography revealed a moderately dilated left ventricleand reduced systolic function. She presented withbreathlessness at the age of 6 years and 1 month and anechocardiograph revealed a deterioration in her heart function,with left ventricular function at 20%.

The girl received furosemide and amiloride. However, hercondition continued to deteriorate and, 1 month later, she washospitalised with acute dyspnoea and tachycardia. A chest x-ray confirmed massive cardiomegaly. She died that eveningfollowing the onset of suspected tachycardic arrhythmia.

Post-mortem heart histology revealed a mild patchylymphocytic infiltrate with interstitial oedema.

Author comment: "Drug induced cardiac toxicity shouldbe considered in patients with [recessive dystrophicepidermolysis bullosa]. Amitriptyline, increasingly used forchronic pain in this condition, may cause cardiomyopathy.Cisapride may have contributed to a final arrhythmic insult inour patient."Taibjee SM, et al. Lethal cardiomyopathy in epidermolysis bullosa associated withamitriptyline. Archives of Disease in Childhood 90: 871-872, No. 8, Aug 2005 -England 801022355

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Reactions 29 Oct 2005 No. 10750114-9954/10/1075-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved