Efficacy and Safety of Clonazepam in Refractory Neurally Mediated Syncope.

Autor: Kadri, Nazih, Hee, Tom T., Rovanc, Karen S., Mohiuddin, Syed M., Ryan, Timothy, Ashraf, Raashid, Huebert, Vincent, Hilleman, Daniel E.
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Zdroj: Pacing & Clinical Electrophysiology; Feb1999, Vol. 22 Issue 2, p307-314, 8p, 1 Diagram, 2 Charts
Abstrakt: Neurally mediated syncope is a complex syndrome that is often difficult to manage using currently available treatment strategies. The efficacy and safety of clonal was evaluated in 35 patients with refractory neurally mediated syncope. All patients had syncope (n=33) or disabling presyncope (n=2) and a positive head-up tilt table test (HUTT) despite treatment with one or more of the following therapies: (β-blocker, high-salt diet, fludrocortisone, elastic compression stockings, and disopyramide. Clonazepam was initiated at 0.5 mg/day and titrated in 0.25-0.5 mg/day Increments for symptom control. Early (first 8 weeks) symptomatic response was achieved in 31 of 35 (89%) patients. Early HUTT reverted to negative in 29 of 35 (83%) patients. Two patients discontinued clonazepam during early follow-up due to side effects. Thirty-three patients received long-term clonazepam therapy. Twenty-five patients had late HUTT with 21 remaining negative. Of the eight patients who did not have late HUTT, one patient discontinued clonazepam prior to HUTT due to side effects. Seven patients refused late HUTT. All seven patients achieved symptomatic control on clonazepam with two requiring dose titration. Of the 21 patients with a negative late HUTT, 18 achieved symptomatic control with two of these patients requiring dose titration. Two patients who had only partial symptom control despite dose titration achieved total symptomatic control with the addition of disopvramide and β-blockers. Two patients with a negative late HUTT discontinued clonazepam due to side effects. One patient had been symptomatically controlled while the other had recurrent symptoms with dose limiting side effects occurring after clonazepam dose titration. In the 4 patients with a positive late HUTT, 2 patients were symptomatically controlled, 1 patient required combination therapy with a β-blocker to achieve symptomatic control, and 1 patient discontinued therapy due to side effects. Overall,... [ABSTRACT FROM AUTHOR]
Databáze: Complementary Index
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