Terapötik tek doz mirtazapine bağlı gelişen semptomatik bradikardi: Bir 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 ve 36.1°C sıcaklık ile takip edildi. 0.5mg atropin IV ve teofilin inhaler uygulandı ve kardiyoloji konsültasyonu Address reprint requests to / Yazışma adresi: Ibrahim Gundogmus, Sultan Abdulhamid Han Training and Research Hospital, Department of Psychiatry, Selimiye Mh. Tibbiye Cd. 34668, Uskudar/Istanbul, Turkey istendi. Atropin ve teofilin uygulamasından sonra, ikinci EKG’de kalp atım hızı 48 atım/dk idi. Bildiğimiz Phone / Telefon: +90-216-542-2020/3760 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 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.

Therapeutic Single-Dose Mirtazapine-Induced Symptomatic Bradycardia: a Case Report

Cardiotoxicity is an important adverse effect of some psychotropic drugs. However, cardiac sideeffects 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, majordepressive disorder was diagnosed and mirtazapine 30mg/day was started. 30 minutes after the firstdose of mirtazapine was brought to the emergency room with syncope, nausea, vomiting. She wasexamined 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 80/50mmHgand a temperature of 36.1°C. 0.5mg atropine IV and theophylline inhaler were administered andcardiology consultation was requested. After atropine and theophylline administration, the heart ratewas 48 beats/min in the second ECG. To the best of our knowledge, it is the first bradycardia developedafter mirtazapine use in the literature. Bradycardia has been resolved after the half-life of mirtazapinehas passed (37 hours for women). The initial heart rate of our patient was within normal limits prior tomirtazapine administration. There was no reason to explain bradycardia, we think that symptomaticbradycardine is caused by mirtazapine. In conclusion, this case report suggests that mirtazapine maycause bradycardia in patients. Risk factors for bradycardia caused by mirtazapine are unknown. Althoughin many patients this bradycardine does not cause a clinical outcome, clinicians should be aware of thisand should perform ECG monitoring in patients with underlying cardiac disease, especially whenprescribing mirtazapine.

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