title: Interaction of serotonin re-uptake inhibitors with perhexiline.
abstract: OBJECTIVE
  To report two cases of perhexiline toxicity associated with selective serotonin re-uptake inhibitor (SSRI) treatment.
  
  
  METHODS
  Serum perhexiline concentrations progressively increased after a 69-year-old man was concurrently prescribed paroxetine for the treatment of depression. An 84-year-old woman was admitted to hospital with severe, symptomatic perhexiline toxicity associated with fluoxetine treatment.
  
  
  METHODS
  In both cases, perhexiline therapy was suspended and treatment with SSRIs was withdrawn.
  
  
  RESULTS
  Serum perhexiline concentrations declined following the withdrawal of paroxetine in one case, but in the case of the second patient perhexiline concentrations were extremely slow to decrease, resulting in referral to a rehabilitative care unit for convalescence.
  
  
  CONCLUSIONS
  Serum perhexiline concentrations may be elevated during concurrent treatment with SSRIs, potentially resulting in severe toxicity.
authors.affiliation: Pharmacy Department, Repatriation General Hospital, Daw Park, Australia.
authors.forename: C P
authors.initials: CP
authors.lastname: Alderman
authors.forename: J D
authors.initials: JD
authors.lastname: Hundertmark
authors.forename: T W
authors.initials: TW
authors.lastname: Soetratma
mesh_terms: D000368:Aged; D065690:Cytochrome P-450 CYP2D6 Inhibitors; D003866:Depressive Disorder / Q000097:blood / Q000188:drug therapy* / Q000523:psychology; D004305:Dose-Response Relationship, Drug; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D005260:Female; D005473:Fluoxetine / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008657:Metabolic Clearance Rate / Q000187:drug effects; D017374:Paroxetine / Q000009:adverse effects* / Q000627:therapeutic use; D010480:Perhexiline / Q000009:adverse effects* / Q000493:pharmacokinetics / Q000627:therapeutic use; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D014665:Vasodilator Agents / Q000009:adverse effects* / Q000493:pharmacokinetics / Q000627:therapeutic use
chemical_list: D065690:Cytochrome P-450 CYP2D6 Inhibitors; D005473:Fluoxetine; D017374:Paroxetine; D010480:Perhexiline; D017367:Selective Serotonin Reuptake Inhibitors; D014665:Vasodilator Agents