title: Hypertension, tachycardia, and reversible cardiomyopathy temporally associated with milnacipran use.
abstract: Elevated catecholamine levels are a well-recognized cause of various types of cardiomyopathy. Causes of catecholamine elevation include tumors, toxins, drugs, emotional stress, and sepsis. Milnacipran is a dual and equipotent inhibitor of norepinephrine and serotonin uptake. It is frequently prescribed as therapy for fibromyalgia, and the drug has a good safety profile. Herein, we report the case of a 42-year-old woman with undefined connective-tissue disease and fibromyalgia who developed a severe and reversible cardiomyopathy while taking recommended doses of milnacipran. The cardiomyopathy was associated with a hyperadrenergic state manifested by tachycardia, hypertension, and elevated plasma catecholamine levels. The discontinuation of milnacipran and the initiation of anti-failure therapy resulted in complete resolution of the cardiomyopathy in 6 months. To our knowledge, this is the first report of milnacipran as a possible cause of catecholamine-induced cardiomyopathy.
authors.affiliation: Saint Joseph's Translational Research Institute, Saint Joseph's Hospital, Atlanta, Georgia 30342, USA. formanm@bellsouth.net
authors.forename: Mervyn B
authors.initials: MB
authors.lastname: Forman
authors.forename: Paul G
authors.initials: PG
authors.lastname: Sutej
authors.forename: Edwin K
authors.initials: EK
authors.lastname: Jackson
mesh_terms: D018759:Adrenergic Uptake Inhibitors / Q000009:adverse effects*; D000328:Adult; D009202:Cardiomyopathies / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D002317:Cardiovascular Agents / Q000627:therapeutic use; D002395:Catecholamines / Q000097:blood; D017023:Coronary Angiography; D003521:Cyclopropanes / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D008279:Magnetic Resonance Imaging; D000078764:Milnacipran; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects*; D013610:Tachycardia / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D013997:Time Factors; D016896:Treatment Outcome; D015854:Up-Regulation
chemical_list: D018759:Adrenergic Uptake Inhibitors; D002317:Cardiovascular Agents; D002395:Catecholamines; D003521:Cyclopropanes; D000078764:Milnacipran; D017367:Selective Serotonin Reuptake Inhibitors