title: Excessive sweating induced by interaction between agomelatine and duloxetine hydrochloride: case report and review of the literature.
abstract: OBJECTIVE
  In this case report, we describe a case in which the clinical pharmacy team was asked to provide recommendations on possible continued use of combination antidepressants in a 62-year-old Slovenian female patient with major depressive disorder following agomelatine and duloxetine hydrochloride-induced excessive sweating. When agomelatine was administered as an additional treatment, drug-induced excessive sweating was observed after a daily intake of 90 mg of duloxetine hydrochloride and 25 mg of agomelatine. After thorough discussion, it was decided not to rechallenge with agomelatine because of the serious adverse effect. After agomelatine discontinuation and switching to trazodone, symptoms immediately improved.
  
  
  CONCLUSIONS
  Duloxetine hydrochloride-induced sweating has been reported frequently, but excessive sweating induced by agomelatine and duloxetine hydrochloride has not been reported in the literature. The adverse effect was determined by a clinical pharmacist using the Naranjo probability scale and was probably associated with agomelatine use (6 points) and possibly associated with duloxetine hydrochloride use (4 points). The exact mechanism for this adverse effect in this patient is not known, but we believe that a pharmacodynamic drug-drug interaction between agomelatine and duloxetine hydrochloride had occurred.
  
  
  CONCLUSIONS
  Such a case has not yet been described in literature; however, an adverse effect associated with drug-drug interaction can occur, as this report clearly demonstrates. The benefits of this antidepressant combination need to be carefully balanced with the risks associated with its use. This case report also highlights the increased potential for adverse reactions when prescribing antidepressant combinations and importance of clinical pharmacists' involvement in the psychiatric patients' pharmacotherapy.
authors.affiliation: Department for Clinical Pharmacy, Psychiatric Hospital Ormož, Ptujska Cesta 33, Ormož, Slovenia. matejstuhec@gmail.com.
authors.forename: Matej
authors.initials: M
authors.lastname: Štuhec
mesh_terms: D000081:Acetamides / Q000009:adverse effects*; D000928:Antidepressive Agents / Q000009:adverse effects; D004338:Drug Combinations; D004347:Drug Interactions; D000068736:Duloxetine Hydrochloride / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006945:Hyperhidrosis / Q000139:chemically induced* / Q000175:diagnosis / Q000517:prevention & control*; D008875:Middle Aged; D009281:Naphthalenes
chemical_list: D000081:Acetamides; D000928:Antidepressive Agents; D004338:Drug Combinations; D000068736:Duloxetine Hydrochloride; C084711:agomelatine; D009281:Naphthalenes
keywords: Agomelatine; Clinical pharmacy; Drug–drug interaction; Duloxetine hydrochloride; Psychiatry; Sweating