Reactions 840 - 24 Feb 2001

STrimipramine/venlafaxine

Generalised seizures: case reportAn episode of generalised seizures occurred during

treatment with venlafaxine and trimipramine for chronicdepression in a 25-year-old woman.

The woman had been receiving trimipramine 50 mg/day for2 months when venlafaxine 75 mg/day was introduced due topersistent depression. The venlafaxine dosage was increasedto 150 mg/day 3 weeks later, and 3 weeks after that dosageincrease, the trimipramine dosage was increased to 100mg/day. She was hospitalised after experiencing a 90-secondseizure 11 days after the dosage of trimipramine wasincreased. The seizure was thought to be a secondarygeneralised grand-mal episode.

Upon examination, the woman had generalised weakness,peripheral hyper-reflexia and a headache. She recalled severalepisodes of impaired consciousness during the 2 days prior tothe seizure, but could not remember the seizure. An ECGshowed right bundle-branch block and block-relatedrepolarisation abnormalities in the V1–V3 leads. An EEG 6 dayslater showed generalised epileptiform episodes. An α rhythmof 8–10Hz was seen posteriorly, which manifested as rhythmic1-second groups of waves, and was most prominent when thewoman had her eyes closed.

Venlafaxine and trimipramine were discontinued. A repeatEEG 6 days later showed persistent, but decreased,epileptogenic activity. The woman was discharged after a2-week hospital stay. She remained symptom-free and did notexperience any episodes of seizures during that time, andduring 12 months of follow-up.

Author comment: ‘We hypothesize that apharmacodynamic and/or a pharmacokinetic drug interactionon the CYP2D6 level may have played an important role in thedevelopment of the seizures’.Schlienger RG, et al. Seizures associated with therapeutic doses of venlafaxine andtrimipramine. Annals of Pharmacotherapy 34: 1402-1405, Dec 2000 -Switzerland 800858039

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Reactions 24 Feb 2001 No. 8400114-9954/10/0840-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved