Use of sertraline hydrochloride in the treatment of refractory neurocardiogenic syncope in children and adolescents.
OBJECTIVE
The purpose of our study was to determine whether the serotonin reuptake inhibitor sertraline hydrochloride could prevent neurocardiogenic syncope in children and adolescents resistant to or intolerant of other therapies.


BACKGROUND
The serotonin reuptake inhibitor fluoxetine hydrochloride has been reported to be effective in preventing neurocardiogenic syncope in adults.


METHODS
Seventeen consecutive young patients (mean age 15 years, range 10 to 18; 7 male, 10 female) with recurrent syncope and a positive head-upright tilt table test, and in whom standard therapies (fludrocortisone, transdermal scopolamine, beta-adrenergic blocking agents, disopyramide) were ineffectual, poorly tolerated or contraindicated, were referred for study. Sertraline was administered orally at 50 mg daily for 4 to 6 weeks. A head-upright tilt table test was then reperformed, and the clinical effect was noted.


RESULTS
Three patients (18%, 95% confidence interval [CI] 1 to 44) were intolerant of the drug, and it was discontinued. Nine patients became asymptomatic and tilt negative (53%, 95% CI 26 to 76), and five remained tilt positive (36%, 95% CI 15 to 65). Over a mean follow-up period of 12 +/- 5 months, the tilt-negative patients remained symptom free while taking sertraline.


CONCLUSIONS
The serotonin reuptake inhibitor sertraline hydrochloride can be effective in preventing recurrent neurocardiogenic syncope in selected patients unresponsive to or intolerant of other therapeutic modalities.
Electrophysiology Section, Medical College of Ohio, Toledo 43699.
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D015057:1-Naphthylamine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000293:Adolescent; D001919:Bradycardia / Q000150:complications; D002648:Child; D005260:Female; D006801:Humans; D007022:Hypotension / Q000150:complications; D008297:Male; D011187:Posture; D012008:Recurrence; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D020280:Sertraline; D013575:Syncope / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology
D015057:1-Naphthylamine; D017367:Selective Serotonin Reuptake Inhibitors; D020280:Sertraline