Can fluoxetine cause polymyalgia rheumatica?/nBackground: an 83-year-old woman developed muscle pai

Fråga: Can fluoxetine cause polymyalgia rheumatica?

Background: an 83-year-old woman developed muscle pain in the shoulders and neck 4 weeks after starting treatment with fluoxetine. A couple of weeks later she showed clinical signs of polymyalgia rheumatica. Her symptoms improved rapidly after treatment with cortisone.

Sammanfattning: No reports could be found on fluoxetine causing polymyalgia rheumatica.

Svar: Musculoskeletal symptoms such as arthritis, bone pain, bursitis, tenosynovitis, myositis and rheumatoid arthritis are all mentioned in the Physicians´ Desk Reference (American FASS) as infrequent or rare side effects of fluoxetine (1). No documentation could be found on fluoxetine (or other serotonin reuptake inhibitors) causing polymyalgia rheumatica or a complex of symptoms resembling this disease (pain and stiffness in shoulders and hips, proximal arthritis, normal CK but increased erythrocyte sedimentation rates) (2).

There are some case reports of serum sickness induced by fluoxetine (3), with symptoms consisting of rash, fever, myalgia, arthralgia and lymphadenopathy.

The Swedish Adverse Drug Reactions Committee (SADRAC) has since 1986 received three reports of musculoskeletal adverse effects possibly caused by fluoxetine. One is a case of vasculitis (purpura on the lower legs and swelling of the left foot) in a 54-year-old woman treated with fluoxetine (20 mg/day) for 3 years and also treated with Propavan. No information was available on the outcome. There is also one case of myopathy and increased transaminase and CK values in a 32-year-old man who had been treated with fluoxetine (20 mg/day) for 5 weeks. He was also treated with fluphenazine. The patient´s condition normalized after the fluoxetine was discontinued. However, an infectious cause for his symptoms was considered more likely by the reporting physician. The third case concerned a 48-year-old man who, after starting treatment with fluoxetine (20 mg/day), gradually developed general malaise and muscle pains. His symptoms disappeared after discontinuation of the drug.

Correspondence with the manufacturer (4) did not reveal any information concerning this question.

We recommend this case be reported to SADRAC. 1 Physicians´ Desk Reference (PDR), 1994; 48th edition: 879
2 Harrison´s Principles of Internal Medicine, 1987; 11th edition: 98
3 Drugline nr 11071 (year 1994)

4 Personal communication with Conny Edlund, Eli Lilly Sweden AB, Stockholm, Sweden