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Serotonin syndrome during treatment with low dose of escitalopram associated with miconazole mucoadhesive tablet: a suspected drug interaction

Published online by Cambridge University Press:  17 January 2012

Grégory Baptista ,
Céline Eiden ,
Paul Monguillot ,
Christelle Philibert  and
Claude Jeandel
Grégory Baptista*
Affiliation:
Department of Internal Medicine and Geriatrics, University Hospital of Montpellier, Montpellier, France
Céline Eiden
Affiliation:
Department of Medical Pharmacology and Toxicology, University Hospital of Montpellier, Montpellier, France
Paul Monguillot
Affiliation:
Department of Internal Medicine and Geriatrics, University Hospital of Montpellier, Montpellier, France
Christelle Philibert
Affiliation:
Department of Medical Pharmacology and Toxicology, University Hospital of Montpellier, Montpellier, France
Claude Jeandel
Affiliation:
Department of Internal Medicine and Geriatrics, University Hospital of Montpellier, Montpellier, France
*
Correspondence should be addressed to: Dr. Gregory Baptista, MD, MSc, Department of Internal Medicine and Geriatrics, University Hospital of Montpellier, 39 avenue Charles Flahault, 34295 Montpellier cedex 5, France. Phone: +33 4 67 33 67 79; Fax: +33 4 67 33 68 87. Email: gregory.baptista@gmail.com.
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Abstract

Antidepressant treatments, including selective serotonin reuptake inhibitors, are associated in older adults with an increased risk of adverse effects compared to younger adults. This is partly explained by multiple drug use causing drug–drug interactions. In the present report, we describe a case of serotonin syndrome in an 88-year-old woman receiving a low dose of escitalopram. The onset of this episode could have been induced by a drug–drug interaction with an acute treatment by miconazole gingival adhesive tablets. The lack of pharmacokinetic data in the elderly population should prompt us to be especially cautious about prescription of this new formulation of miconazole in association with drugs metabolized by cytochromes P450 isoenzymes.

Keywords

miconazoleescitalopramcytochrome P450serotonin syndromedrug interactionelderly
Type
Case Report
Information
International Psychogeriatrics , Volume 24 , Issue 5 , May 2012 , pp. 845 - 847
Copyright
Copyright © International Psychogeriatric Association 2012

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