Hostname: page-component-cd9895bd7-8ctnn Total loading time: 0 Render date: 2024-12-25T06:03:11.311Z Has data issue: false hasContentIssue false

Serotonin syndrome during treatment with low dose of escitalopram associated with miconazole mucoadhesive tablet: a suspected drug interaction

Published online by Cambridge University Press:  17 January 2012

Grégory Baptista*
Affiliation:
Department of Internal Medicine and Geriatrics, University Hospital of Montpellier, Montpellier, France
Céline Eiden
Affiliation:
Department of Medical Pharmacology and Toxicology, University Hospital of Montpellier, Montpellier, France
Paul Monguillot
Affiliation:
Department of Internal Medicine and Geriatrics, University Hospital of Montpellier, Montpellier, France
Christelle Philibert
Affiliation:
Department of Medical Pharmacology and Toxicology, University Hospital of Montpellier, Montpellier, France
Claude Jeandel
Affiliation:
Department of Internal Medicine and Geriatrics, University Hospital of Montpellier, Montpellier, France
*
Correspondence should be addressed to: Dr. Gregory Baptista, MD, MSc, Department of Internal Medicine and Geriatrics, University Hospital of Montpellier, 39 avenue Charles Flahault, 34295 Montpellier cedex 5, France. Phone: +33 4 67 33 67 79; Fax: +33 4 67 33 68 87. Email: [email protected].
Get access

Abstract

Antidepressant treatments, including selective serotonin reuptake inhibitors, are associated in older adults with an increased risk of adverse effects compared to younger adults. This is partly explained by multiple drug use causing drug–drug interactions. In the present report, we describe a case of serotonin syndrome in an 88-year-old woman receiving a low dose of escitalopram. The onset of this episode could have been induced by a drug–drug interaction with an acute treatment by miconazole gingival adhesive tablets. The lack of pharmacokinetic data in the elderly population should prompt us to be especially cautious about prescription of this new formulation of miconazole in association with drugs metabolized by cytochromes P450 isoenzymes.

Type
Case Report
Copyright
Copyright © International Psychogeriatric Association 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Boyer, E. W. and Shannon, M. (2005). The serotonin syndrome. New England Journal of Medicine, 352, 11121120.CrossRefGoogle ScholarPubMed
Cardot, J. M., Chaumont, C., Dubray, C., Costantini, D. and Aiache, J. M. (2004). Comparison of the pharmacokinetics of miconazole after administration via a bioadhesive slow release tablet and an oral gel to healthy male and female subjects. British Journal of Clinical Pharmacology, 58, 345351.CrossRefGoogle Scholar
Hynninen, V. V., Olkkola, K. T., Neuvonen, P. J. and Laine, K. (2009). Oral voriconazole and miconazole oral gel produce comparable effects on the pharmacokinetics and pharmacodynamics of etoricoxib. European Journal of Clinical Pharmacology, 65, 8995.CrossRefGoogle ScholarPubMed
Jacob, S. and Spinler, S. A. (2006). Hyponatremia associated with selective serotonin-reuptake inhibitors in older adults. Annals of Pharmacotherapy, 40, 16181622.CrossRefGoogle ScholarPubMed
Lalla, R. V. and Bensadoun, R. J. (2011). Miconazole mucoadhesive tablet for oropharyngeal candidiasis. Expert Review of Anti-Infective Therapy, 9, 1317.CrossRefGoogle ScholarPubMed
Mark, T. L., Joish, V. N., Hay, J. W., Sheehan, D. V., Johnston, S. S. and Cao, Z. (2010). Antidepressant use in geriatric populations: the burden of side effects and their impact on adherence and costs. American Journal of Geriatric Psychiatry, 19, 211221.CrossRefGoogle Scholar
Naranjo, C. A. et al. (1981). A method for estimating the probability of adverse drug reactions. Clinical Pharmacology & Therapeutics, 30, 239245.CrossRefGoogle ScholarPubMed
Niwa, T., Inoue-Yamamoto, S., Shiraga, T. and Takagi, A. (2005a). Effect of antifungal drugs on cytochrome P450 (CYP) 1A2, CYP2D6, and CYP2E1 activities in human liver microsomes. Biological & Pharmaceutical Bulletin, 28, 18131816.CrossRefGoogle ScholarPubMed
Niwa, T., Shiraga, T. and Takagi, A. (2005b). Effect of antifungal drugs on cytochrome P450 (CYP) 2C9, CYP2C19, and CYP3A4 activities in human liver microsomes. Biological & Pharmaceutical Bulletin, 28, 18051808.CrossRefGoogle ScholarPubMed
Ortín, M., Olalla, J. I., Muruzábal, M. J., Peralta, F. G. and Gutiérrez, M. A. (1999). Miconazole oral gel enhances acenocoumarol anticoagulant activity: a report of three cases. Annals of Pharmacotherapy, 33, 175177.CrossRefGoogle ScholarPubMed
Pemberton, M. N., Oliver, R. J. and Theaker, E. D. (2004). Miconazole oral gel and drug interactions. British Dental Journal, 196, 529531.CrossRefGoogle ScholarPubMed