Ciclosporin/venlafaxine interaction
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Bradycardia: case report A 38-year-old woman developed bradycardia following concomitant administration of ciclosporin and venlafaxine. The woman, who had systemic lupus erythematosus (diagnosed 5 years ago), was hospitalised in Iran due to chronic rheumatologic symptoms and abdominal pain. She started receiving ciclosporin tablet 50mg twice a day. Her medical history was significant for mood disorders for which she had received various medications, and two suicidal attempts in the past. She had been receiving quetiapine 100mg every night since then. During the hospitalisation, she did not have suicidal thoughts. Her quetiapine therapy was continued, and she started receiving venlafaxine 37.5 mg/day. Before initiation of venlafaxine, she did not have bradycardia; however, she became bradycardic (HR 52 ppm [sic]) after administration of the single dose of venlafaxine. Her left ventricular ejection fraction (LVEF) was found to be 55 [unit not stated]. It was later determined that the bradycardia might had occurred due to pharmacokinetic interaction between venlafaxine and ciclosporin. According to the Naranjo adverse drug reactions (ADR) probability scale, the event bradycardia was probably related to the drug venlafaxine (score 8). The woman’s all the drugs were therefore discontinued. Within 48h of the drug discontinuation, her bradycardia gradually resolved. Author comment: "The aim of this study was to introduce a case presentation on bradycardia due to the drug interference of venlafaxine and [ciclosporin]." "Venlafaxine. . .have the strongest inhibitory action on the CYP3A3/4 isoenzyme and decreased [ciclosporin] metabolism". "The Naranjo adverse drug reactions (ADR) probability scale. . .venlafaxine with a probable ADR (score 8) was considered as the cause of bradycardia in this patient." Azizi M, et al. Bradycardia caused by interaction of venlafaxine and cyclosporine: A case report. Caspian Journal of Internal Medicine 10: 463-467, No. 4, Sep 2019. 803431791 Available from: URL: http://doi.org/10.22088/cjim.10.4.463 - Iran
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Reactions 9 Nov 2019 No. 1778
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