The question concerns with a 47-year-old man, 194 cm tall and 110 kg, who since October has fainted

Fråga: The question concerns with a 47-year-old man, 194 cm tall and 110 kg, who since October has fainted six times and there is no connection with physical body position or with a change thereof. A neurologist has not found any explanation to the fainting and further examinations will be performed by a cardiologist. The patient is being treated with dextropropoxyphen 100 mg four times daily and paracetamol one gram four times daily due to problems with his back. Can the fainting be due to the drug treatment?

Sammanfattning: Paracetamol has not been associated with syncope. Dextropropoxyphen has in a limited number of cases been associated with syncope.

Svar: In the Swedish side-effect register Swedis (1) there are no cases convincingly suggesting a connection between paracetamol and fainting. For dextropropoxyphen there are at least three cases were a connection between fainting and intake of dextropropoxyphen has been considered possible or probable. In the World Health Organization side-effect register (2) there are 16 cases reported of syncope. We have not been able to locate any case reports or other literature in Medline (3). In addition, cardiovascular adverse effects of dextropropoxyphen has been discussed as a cause of death following intoxication (4). It therefore seems possible that dextropropoxyphen has been the causative agent in the present case. It is suggested that the drug is withdrawn and if no more incidences of fainting appears the case should be reported to the Swedish Adverse Drug Reactions Advisory Committe (SADRAC).