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Transient ischemic
attack reported with paroxetine use.
Manos GH,
Wechsler SM.
Department of Psychiatry, Naval Medical Center
Portsmouth, Portsmouth, VA 23708-2197, USA.
ghmanos@mar.med.navy.mil
OBJECTIVE: To report the occurrence of a
transient ischemic attack (TIA) temporally related to the initiation of
paroxetine. CASE SUMMARY: A 57-year-old white man with a history of
intermittent atrial fibrillation and hypercholesterolemia developed
slurred speech and a facial droop 3 days after starting paroxetine. He
was diagnosed with a TIA, hospitalized, and given anticoagulation
treatment. The presenting symptoms resolved, but recurred when
paroxetine was restarted 2 days later. DISCUSSION: Platelets secrete
serotonin, which mediates vasoconstriction through stimulation of 5-HT2a
receptors. This is counterbalanced by the release of the vasodilator
nitric oxide upon serotonin stimulation of endothelial 5-HT1 receptors.
In conditions such as atherosclerosis, the damage to the endothelium
leads to a greater vasoconstrictive response. Paroxetine has been
reported to weakly inhibit norepinephrine reuptake and nitric oxide
production in addition to increasing serotonergic activity, potentially
compounding the vasoconstrictive response. An objective causality
assessment revealed that the TIA was probably an adverse event resulting
from use of paroxetine. CONCLUSIONS: Use of paroxetine and other
selective serotonin-reuptake inhibitors may result in changes of the
vasculature and subsequent ischemic events in predisposed
patients.
Publication Types:
PMID: 14966255 [PubMed - indexed for
MEDLINE]
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