title: Extrapyramidal symptoms with concomitant use of amitriptyline and amiodarone in an elderly patient.
abstract: BACKGROUND
  Amitriptyline is a tricyclic antidepressant useful for the treatment of depression. Amiodarone is a class III antiarrhythmic agent used for the treatment of cardiac dysrhythmias.
  
  
  OBJECTIVE
  The objective of the current report is to describe the case of a previously asymptomatic patient receiving amitriptyline who developed extrapyramidal symptoms within 1 month of initiating concomitant treatment with amiodarone for atrial fibrillation.
  
  
  METHODS
  An 82-year-old, right-handed, white woman was brought to the medical center's emergency department with speech difficulty suggesting stroke. She was noted to have continuous orobuccal dyskinesias, upper and lower extremity shaking, and dry mouth. Once it was determined that no other focal neurologic findings indicated stroke, her medications were reviewed. The patient had been taking amitriptyline 50 mg/d for the past year for insomnia without any adverse events. However, 1 month before presentation, she also initiated treatment with amiodarone 200 mg/d for atrial fibrillation and had developed the symptoms of concern shortly thereafter. The patient's amitriptyline treatment was discontinued and she received benzotropine for extrapyramidal symptoms from amitriptyline toxicity. She experienced complete resolution of dysarthric speech and limb shaking within 2 days. A total score of 7 was achieved using Naranjo's adverse drug reaction causality algorithm, suggesting amitriptyline was a probable cause of these adverse events.
  
  
  CONCLUSIONS
  This was a probable case of extrapyramidal symptoms in an elderly woman who began using amiodarone while also taking amitriptyline.
authors.affiliation: Department of Neurology, Medical College of Wisconsin, Clement J. Zablocki Veterans Administration Medical Center, Milwaukee, USA. ppawar@mcw.edu
authors.forename: Pritish S
authors.initials: PS
authors.lastname: Pawar
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Woo
mesh_terms: D000369:Aged, 80 and over; D000638:Amiodarone / Q000009:adverse effects* / Q000627:therapeutic use; D000639:Amitriptyline / Q000009:adverse effects* / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects / Q000627:therapeutic use; D000929:Antidepressive Agents, Tricyclic / Q000009:adverse effects / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy; D001480:Basal Ganglia Diseases / Q000139:chemically induced*; D004347:Drug Interactions; D005260:Female; D006801:Humans
chemical_list: D000889:Anti-Arrhythmia Agents; D000929:Antidepressive Agents, Tricyclic; D000639:Amitriptyline; D000638:Amiodarone