Year: 1990
Type: article
Abstract: Parkinson's disease, had selegiline 5 mg q.a.m. added to her previous regime of Parlodel 5 mg t.i.d. and Sinemet 100/25, 8 tablets per day in January of 1990.She was also on amitriptyline, for depression which was discontinued in March of 1990 because of urinary hesitancy.The patient was started on fluoxetine 20 mg q.a.m.Several days after starting the fluoxetine, the patient started to develop episodes, during which she would shiver and break out into a cold sweat.The episodes would start in midafternoon, and last for several hours.On these occasions, she would feel very clammy, and her hands would be cold.She was seen in the office for assessment one month later.At that time, it was noted that she was very diaphoretic.Her hands were severely vasoconstricted, and the fingers were blue and mottled.Her blood pressure was 200/120.Previously, the patient had had transient elevations of blood pressure, which were usually induced by stress, but she did not feel under stress on this occasion.The selegiline and fluoxetine were both discontinued, and she recovered over the next few days.Her blood pressure returned to normal (120/90).She did not have any further diaphoretic episodes.She has since restarted fluoxetine with no side-effects.This patient developed a very unusual reaction, which has not been reported previously with either selegiline or fluoxetine.As she was able to tolerate both medications independently, it would appear to be specifically due to this combination.Selegiline, a selective MAOB inhibitor at low doses (5-10 mg a day) has been reported to cause hypertension, when taken in high doses, due to loss of selectivity. 4However, this patient was taking only 5 mg a day and use of deprenyl alone did not cause any elevation of BP on previous visits.Several reports have suggested that administration of tranylcypromine, a non selective MAO inhibitor together with fluoxetine, may result in a "serotonin syndrome" characterized by shivering, diaphoresis, diplopia, nausea and confusion. 5The temporal sequence of this patient's symptoms, suggests that the episodes of diaphoresis and hypertension may have been due to the combination of fluoxetine and selegiline, and may be similar to the serotonin syndrome reported previously.No previous reports of a possible interaction between Deprenyl and Prozac have been reported in Canada to this date.However representatives from the manufacturer of Prozac have indicated that they are aware of several reports in the U.S. and that they are recommending that Selegiline and Fluoxetine not be used in combination.
Authors: Edward C. Mun, Eugene Rossitch, Matthew R. Moore, Peter McL. Black
Institutions: Brigham and Women's Hospital, Duke University, Duke Medical Center
Language: English
Subfield: Clinical Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2409970496