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Seizures associated with
therapeutic doses of venlafaxine and
trimipramine.
Schlienger RG, Klink MH, Eggenberger
C, Drewe J.
Department of Internal Medicine, University
Hospital Basel, Switzerland. juergen.drewe@unibas.ch
OBJECTIVE:
To report a patient having a first-time seizure after receiving
venlafaxine and trimipramine for depression. CASE SUMMARY: A 25-year-old
white woman with chronic depression was treated with venlafaxine 150
mg/d and trimipramine 50 mg/d. Eleven days after increase of the
trimipramine dosage to 100 mg/d, she was hospitalized because of
seizures suggesting a secondary generalized grand-mal episode. The
electroencephalogram showed a pathologic pattern with several
generalized epileptiform discharges. Because of suspected drug-induced
seizures, both antidepressants were stopped. After antidepressant drug
cessation, the patient was symptom free and had no further seizure
episodes within the following 12 months of follow-up. No other potential
cause for the seizure episode could be identified. DISCUSSION: Both
venlafaxine and trimipramine have been associated with seizures, mainly
after overdose. Venlafaxine-associated seizures at therapeutic doses
have not been reported in the literature. We hypothesize that a
pharmacodynamic or pharmacokinetic drug interaction between venlafaxine
and trimipramine involving the CYP2D6 isoenzyme may have played a role
in inducing the seizures. CONCLUSIONS: Clinicians should be aware of the
proepileptogenic effect of venlafaxine and trimipramine at therapeutic
doses and that this combination may eventually increase the risk of
seizures.
Publication Types:
PMID: 11144696 [PubMed - indexed for
MEDLINE]
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