Preliminary observations on the effect of amitriptyline treatment in preventing syncope recurrence in patients with vasovagel syncope.
OBJECTIVE
Vasovagal syncope is a common and challenging problem that may result in injury and causes substantial anxiety among patients and their relatives. However, treatment of vasovagal syncope with standard pharmacologic approaches is not satisfactory. The aim of this study is to investigate the effect of amitriptyline, a tricyclic antidepressant drug, by using its anticholinergic effects in preventing syncopal episodes in patients with vasovagal syncope.


METHODS
In this study, 74 patients (mean age 24 +/- 1.9 years, 26 male) with a history of recurrent syncope and baseline positive head-up tilt table test (syncope or presyncope) were included. Oral amitriptyline treatment was given to all patients, with a starting dose of 10 mg once a day. Head-up tilt table test was performed in all patients 4 weeks after the treatment started. Patients were followed up clinically for 6 months.


RESULTS
After 4 weeks, during head-up tilt table test in 69 patients (93%), syncope or presyncope was not seen and test was assumed as negative. At the end of the 6th month, 67 patients (91%) were free of symptoms. Only two patients (0.3%) did not tolerate amitriptyline due to side effects.


CONCLUSIONS
Oral amitriptyline can be used in the prevention of recurrent episodes of vasovagal syncope safely. However, randomized controlled studies are essential to assess the real effectiveness of this therapy.
Bariş Kaya
Ergün
E
Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey. doctorkaya@yahoo.com
Abali
Gülcan
G
Aytemir
Kudret
K
Köse
Sedat
S
Kocabaş
Uğur
U
Tokgözoğlu
Lale
L
Kabakçi
Giray
G
Amasyali
Basri
B
Ozkutlu
Hilmi
H
Nazli
Nasih
N
Oto
Ali
A
D000284:Administration, Oral; D018759:Adrenergic Uptake Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D000328:Adult; D000639:Amitriptyline / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D055502:Secondary Prevention; D019462:Syncope, Vasovagal / Q000517:prevention & control*; D018667:Tilt-Table Test; D016896:Treatment Outcome
D018759:Adrenergic Uptake Inhibitors; D000639:Amitriptyline