[Effectiveness of paroxetine in the treatment of refractory vasovagal syncope in young patients].
OBJECTIVE
The aim of the study was to assess whether the well-tolerated serotonin re-uptake inhibitor paroxetine hydrochloride could prevent vasovagal syncope in young patients resistant to or intolerant of previous traditional therapies.


BACKGROUND
Serotonergic mechanisms may play a major role in the pathophysiology of neurocardiogenic syncope, and serotonin re-uptake inhibitors have been recently reported to be effective in preventing episodes.


METHODS
Forty-one consecutive young patients (13 male and 28 female), aged less than thirty years with recurrent syncope and positive head-up tilt test, and in whom standard therapies with beta-blocking, vagolytic, negative inotropic or mineral corticoid agents were ineffectual, poorly tolerated or contraindicated, randomly received either paroxetine at 20 mg once a day or a placebo. A head-up tilt test was then re-performed after one month of treatment, and the clinical effect was noted over a mean follow-up of 27.1 +/- 6.6 months.


RESULTS
The response rates (negative tilt test) after one month of treatment were 57.1 versus 33.3% (p < 0.001) in the paroxetine and placebo groups, respectively. During follow-up, spontaneous syncope was observed in 4 patients (19%) in the paroxetine group and in 12 patients (60%) in the placebo group (p < 0.001). Only one patient (4.8%) asked to be discontinued from the drug for severe recurrent headache.


CONCLUSIONS
Paroxetine significantly improved symptoms of young patients with recurrent vasovagal syncope unresponsive to or intolerant of traditional medications and was well tolerated by patients.
Di Girolamo
E
E
Dipartimento Medico e Chirurgico di Cardiologia, Scuola di Cardiologia, Università G. D'Annunzio, Chieti.
Di Iorio
C
C
Leonzio
L
L
Sabatini
P
P
Ranalli
G
G
Barsotti
A
A
D000328:Adult; D000367:Age Factors; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D017374:Paroxetine / Q000627:therapeutic use*; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D019462:Syncope, Vasovagal / Q000188:drug therapy*
D017374:Paroxetine; D017367:Selective Serotonin Reuptake Inhibitors