Case Report of a Syncopal Episode Associated with Fluoxetine

Abstract

OBJECTIVE: To report a syncopal episode associated with fluoxetine in a young, relatively healthy man. DESIGN: Single case report. SETTING: 585-bed private hospital. PATIENT: A 30-year-old man with hypertension, esophageal ulcers, and syncope of recent onset. RESULTS: Fluoxetine was started six weeks prior to the syncopal episode in this patient, and is the medication most temporally associated with the event. Because the patient had a normal neurologic examination and electroencephalogram, but an abnormal electrocardiogram on admission and one month after discharge, the syncopal episode was most likely caused by cardiovascular effects of fluoxetine. CONCLUSIONS: Fluoxetine has been reported to cause cardiac conduction abnormalities in otherwise normal individuals. Bradycardia secondary to a direct effect of fluoxetine, or to a drug interaction among fluoxetine, ranitidine, and enalapril is the most likely explanation for this patient's syncopal episode.