Frågedatum: 1994-11-07
RELIS database 1994; id.nr. 10378, DRUGLINE
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Cutaneous side-effects of amitriptyline (Tryptizol)./nThe question concerns a 56-year-old female tr



Fråga: Cutaneous side-effects of amitriptyline (Tryptizol). The question concerns a 56-year-old female treated with amitriptyline for six years on the indication of a panic disorder. The previous daily dose was 125 mg rendering a plasma concentration of 340 nmol/l in 1991. The last two months the dose was 50 mg. Six weeks ago the patient developed recurrent fever and an itching skin rash with macula and the treatment was stopped. The rash and the fever disappeared for a couple of weeks, but then reappeared. Could this be caused by amitriptyline? The patient is taking no other drugs. The patient is working at a drug company handling different kinds of drugs including Bricanyl (terbutaline), and has been assessed by a general practitioner, a dermatologist, a specialist in occupational medicine and a psychiatrist, all with different opinions.

Sammanfattning: Tricyclic antidepressants may cause cutaneous side-effects, but the occurrence of cutaneous manifestations 5-6 years after the initiation of amitriptyline treatment makes a connection unlikely. Further the remanifestation of cutaneous reactions some weeks after the discontinuation of amitriptyline seems unlikely to be connected with amitriptyline.

Svar: Cutaneous side-effects have been described in previous Drugline answers concerning tricyclic antidepressants (1), but are generally considered rare (2). Furthermore, amitriptyline may produce more cutaneous side-effects than imipramine (1).

Concerning this patient the sequence and time of events makes a connection less likely. Even though skin manifestations may take years to appear in special cases (3), it seems unlikely that the described unspecific symptoms should suddenly appear 5-6 years after the beginning of treatment, as the normal latency time for cutaneous eruptions is maximum 2-3 weeks after initiation of treatment (3). Furthermore, the reappearance of the cutaneous symptoms some weeks after treatment discontinuation makes a connection unlikely.

Bricanyl (terbutaline) is well known to cause cutaneous side-effects (4).

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