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J Cardiovasc Electrophysiol. 2013 Jul;24(7):799-803. doi: 10.1111/jce.12111. Epub 2013 Feb 27.

Norepinephrine transport inhibition for treatment of vasovagal syncope.

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  • 1Libin Cardiovascular Institute of Calgary, Calgary, Alberta, Canada. sheldon@ucalgary.ca

Abstract

INTRODUCTION:

Norepinephrine transporter inhibitors, such as sibutramine, have been shown to prevent vasovagal syncope induced by tilt testing in healthy volunteers. As a test of concept we assessed whether sibutramine prevents fainting in highly symptomatic VVS patients.

METHODS AND RESULTS:

This was an open label, dose-ranging protocol of sibutramine 10, 15, and 20 mg daily for ≥4 weeks per dose, with progression dictated by response and tolerance. Responders were predefined as having >50% reduction in spell frequency, compared to baseline spell frequency. The cohort included seven subjects (6 women; 32 ± 7 years) who had a median of 593 faints over a median of 180 months. The patients had had 7 ± 4 previous treatment attempts without a satisfactory response. The mean duration of exposure to 10 mg, 15 mg, and 20 mg doses were 45 ± 33 days, 98 ± 89 days, and 137 ± 83 days. Six patients tolerated the maximum dose, and 1 patient dropped out due to adverse effects at 15 mg/day. The median frequency of spells at baseline, 10, 15, and 20 mg/day was 12, 4.4, 2.8, and 1 events/28 days (P = 0.0048). Five patients were responders and 2 were nonresponders. Among responders, the median frequency of spells at baseline, 10, 15, and 20 mg/day was 14, 4.8, 0.8, and 0.4 events per 28 days (P = 0.0089). No patients developed hypertension.

CONCLUSION:

In this open label series, sibutramine prevented vasovagal syncope in most highly symptomatic patients.

© 2013 Wiley Periodicals, Inc.

KEYWORDS:

hypotension; norepinephrine transporter; sibutramine; syncope; vasovagal

PMID:
23444896
[PubMed - indexed for MEDLINE]
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