Therapeutic single-dose mirtazapine-induced symptomatic bradycardia: a case report
Pinar Demir Gundogmus, Ibrahim Gundogmus, Emrah Burak Olcu, Abdulkadir Karagoz, Ayhan Algul
Dusunen Adam The Journal of Psychiatry and Neurological Sciences
2018;31:304-307
Article No:
9
Article Type :
Case Report
Cardiotoxicity is an important adverse effect of some psychotropic drugs. However, cardiac side effects with mirtazapine, which is used for an effective treatment of depression and anxiety, are rare. In this article, a forty-eight-year-old woman referred to psychiatric clinics with depressive symptoms. According to Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) criteria, major depressive disorder was diagnosed and mirtazapine 30mg/day was started. 30 minutes after the first dose of mirtazapine was brought to the emergency room with syncope, nausea, vomiting. She was examined in emergency service. Routine blood tests and ECG was studied. During the examination, the patient was followed up with a heart rate of 33 beats per minute, blood pressure arterial 80/50mmHg and a temperature of 36.1°C. 0.5mg atropine IV and theophylline inhaler were administered and cardiology consultation was requested. After atropine and theophylline administration, the heart rate was 48 beats/min in the second ECG. To the best of our knowledge, it is the first bradycardia developed after mirtazapine use in the literature. Bradycardia has been resolved after the half-life of mirtazapine has passed (37 hours for women). The initial heart rate of our patient was within normal limits prior to mirtazapine administration. There was no reason to explain bradycardia, we think that symptomatic bradycardine is caused by mirtazapine. In conclusion, this case report suggests that mirtazapine may cause bradycardia in patients. Risk factors for bradycardia caused by mirtazapine are unknown. Although in many patients this bradycardine does not cause a clinical outcome, clinicians should be aware of this and should perform ECG monitoring in patients with underlying cardiac disease, especially when prescribing mirtazapine.
Keywords :
Bradycardia, mirtazapine, side effect
Terapötik tek doz mirtazapine bağlı gelişen semptomatik bradikardi: Bir olgu sunumu
Makale No:
9
Makale Türü :
Olgu Sunumu
Kardiyotoksisite bazı psikotrop ilaçların önemli bir yan etkisidir. Bununla birlikte, depresyon ve anksiyetenin etkili tedavisi için kullanılan mirtazapin ile kardiyak yan etkiler nadirdir. Bu yazıda, kırk sekiz yaşında bir kadın, depresif belirtileri olan psikiyatri kliniğine başvurdu. DSM-5 kriterlerine göre majör depresif bozukluk tanısı konmuş ve mirtazapin 30mg/gün başlanmıştır. Mirtazapinin ilk dozundan 30 dakika sonra senkop, mide bulantısı, kusma ile acil servise getirildi. Acil serviste muayene edildi. Rutin kan testleri ve EKG çalışıldı. Muayene sırasında hasta kalp atım hızı dakikada 33 atım, kan basıncı arteriyel 80/50mmHg ve 36.1°C sıcaklık ile takip edildi. 0.5mg atropin IV ve teofilin inhaler uygulandı ve kardiyoloji konsültasyonu istendi. Atropin ve teofilin uygulamasından sonra, ikinci EKG’de kalp atım hızı 48 atım/dk idi. Bildiğimiz kadarıyla, literatürde mirtazapin kullanımından sonra geliştirilen ilk bradikardidir. Bradikardi, mirtazapinin yarı ömrü sona erdikten sonra geriledi (kadınlar için 37 saat). Olgumuzun ilk kalp hızı, mirtazapin uygulamasından önce normal sınırlardaydı. Bradikardi açıklamak için hiçbir neden yoktu, biz semptomatik bradikardine mirtazapin neden olduğunu düşünüyoruz. Sonuç olarak, bu olgu sunumu mirtazapinin hastalarda bradikardiye neden olabileceğini düşündürmektedir. Mirtazapinin neden olduğu bradikardi için risk faktörleri bilinmemektedir. Birçok hastada bu bradikardinin klinik bir sonuca neden olmamasına rağmen, klinisyenler bunun farkında olmalı ve özellikle mirtazapin reçete ederken altta yatan kalp hastalığı olan hastalarda EKG izlemi yapmalıdır.
Anahtar kelimeler :
Bradikardi, mirtazapin, yan etki
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