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Related Experiment Videos

Syncope associated with concurrent amitriptyline and fluconazole therapy.

R F Robinson1, M C Nahata, R S Olshefski

  • 1Fellow in Pediatric Pharmacotherapy, The Ohio State University, Children's Hospital, Columbus 43210-1291, USA.

The Annals of Pharmacotherapy
|January 6, 2001
PubMed
Summary
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A young patient experienced syncope (fainting) due to a drug interaction between amitriptyline and fluconazole. This interaction likely increased amitriptyline levels, causing adverse effects confirmed by readministration.

Area of Science:

  • Pharmacology
  • Pediatric Oncology
  • Clinical Toxicology

Background:

  • Rhabdomyosarcoma treatment often involves chemotherapy and supportive care medications.
  • Amitriptyline is used for neuropathic pain, while fluconazole treats fungal infections like mucositis.

Observation:

  • A 12-year-old male with rhabdomyosarcoma experienced recurrent syncope during fluconazole administration.
  • These episodes coincided with stable amitriptyline use for neuropathic pain.
  • Syncope resolved upon amitriptyline discontinuation and recurred upon readministration with fluconazole.

Findings:

  • Concurrent fluconazole administration likely inhibited amitriptyline metabolism, increasing its serum concentration.
  • This drug-drug interaction is supported by three adult case reports and known amitriptyline overdose effects.

Related Experiment Videos

  • The patient's recurrent syncope upon readministration strongly indicates a drug interaction.

    • Implications:

    • Clinicians should be aware of the potential for serious drug interactions between fluconazole and amitriptyline, especially in pediatric patients.
    • Monitoring of amitriptyline levels may be warranted when co-administered with fluconazole.
    • This case highlights the importance of considering drug interactions in unexplained syncopal episodes during treatment.