[Effectiveness of paroxetine in the treatment of refractory vasovagal syncope in young patients].

Abstract

OBJECTIVES:

The aim of the study was to assess whether the well-tolerated serotonin re-uptake inhibitor paroxetine hydrochloride could prevent vasovagal syncope in young patients resistant to or intolerant of previous traditional therapies.

BACKGROUND:

Serotonergic mechanisms may play a major role in the pathophysiology of neurocardiogenic syncope, and serotonin re-uptake inhibitors have been recently reported to be effective in preventing episodes.

METHODS:

Forty-one consecutive young patients (13 male and 28 female), aged less than thirty years with recurrent syncope and positive head-up tilt test, and in whom standard therapies with beta-blocking, vagolytic, negative inotropic or mineral corticoid agents were ineffectual, poorly tolerated or contraindicated, randomly received either paroxetine at 20 mg once a day or a placebo. A head-up tilt test was then re-performed after one month of treatment, and the clinical effect was noted over a mean follow-up of 27.1 +/- 6.6 months.

RESULTS:

The response rates (negative tilt test) after one month of treatment were 57.1 versus 33.3% (p < 0.001) in the paroxetine and placebo groups, respectively. During follow-up, spontaneous syncope was observed in 4 patients (19%) in the paroxetine group and in 12 patients (60%) in the placebo group (p < 0.001). Only one patient (4.8%) asked to be discontinued from the drug for severe recurrent headache.

CONCLUSIONS:

Paroxetine significantly improved symptoms of young patients with recurrent vasovagal syncope unresponsive to or intolerant of traditional medications and was well tolerated by patients.

• Authors: E Di Girolamo, C Di Iorio, L Leonzio, P Sabatini, G Ranalli, A Barsotti
• Journal: Giornale italiano di cardiologia (G Ital Cardiol) Vol. 29 Issue 12 Pg. 1472-7 (Dec 1999) ISSN: 0046-5968 [Print] Italy
• Vernacular Title: Efficacia della paroxetina nel trattamento della sincope vasovagale refrattaria in pazienti giovani.
• PMID: 10687110 (Publication Type: Clinical Trial, English Abstract, Journal Article, Randomized Controlled Trial)

Chemical References

• Serotonin Uptake Inhibitors
• Paroxetine

Topics

• Adult
• Age Factors
• Double-Blind Method
• Female
• Follow-Up Studies
• Humans
• Male
• Paroxetine (therapeutic use)
• Selective Serotonin Reuptake Inhibitors (therapeutic use)
• Syncope, Vasovagal (drug therapy)