Case report of a syncopal episode associated with fluoxetine.

OBJECTIVE To report a syncopal episode associated with fluoxetine in a young, relatively healthy man. DESIGN Single case report. SETTING 585-bed private hospital. PATIENT A 30-year-old man with hypertension, esophageal ulcers, and syncope of recent onset. RESULTS Fluoxetine was started six weeks prior to the syncopal episode in this patient, and is the medication most temporally associated with the event. Because the patient had a normal neurologic examination and electroencephalogram, but an abnormal electrocardiogram on admission and one month after discharge, the syncopal episode was most likely caused by cardiovascular effects of fluoxetine. CONCLUSIONS Fluoxetine has been reported to cause cardiac conduction abnormalities in otherwise normal individuals. Bradycardia secondary to a direct effect of fluoxetine, or to a drug interaction among fluoxetine, ranitidine, and enalapril is the most likely explanation for this patient's syncopal episode.