Norepinephrine transport inhibition for treatment of vasovagal syncope
Abstract
INTRODUCTION: Norepinephrine transporter inhibitors, such as sibutramine, have been shown to prevent vasovagal syncope induced by tilt testing in healthy volunteers. As a test of concept we assessed whether sibutramine prevents fainting in highly symptomatic VVS patients. METHODS AND RESULTS: This was an open label, dose-ranging protocol of sibutramine 10, 15, and 20 mg daily for ≥4 weeks per dose, with progression dictated by response and tolerance. Responders were predefined as having >50% reduction in spell frequency, compared to baseline spell frequency. The cohort included seven subjects (6 women; 32 ± 7 years) who had a median of 593 faints over a median of 180 months. The patients had had 7 ± 4 previous treatment attempts without a satisfactory response. The mean duration of exposure to 10 mg, 15 mg, and 20 mg doses were 45 ± 33 days, 98 ± 89 days, and 137 ± 83 days. Six patients tolerated the maximum dose, and 1 patient dropped out due to adverse effects at 15 mg/day. The median frequency of spells at baseline, 10, 15, and 20 mg/day was 12, 4.4, 2.8, and 1 events/28 days (P = 0.0048). Five patients were responders and 2 were nonresponders. Among responders, the median frequency of spells at baseline, 10, 15, and 20 mg/day was 14, 4.8, 0.8, and 0.4 events per 28 days (P = 0.0089). No patients developed hypertension. CONCLUSION: In this open label series, sibutramine prevented vasovagal syncope in most highly symptomatic patients.
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In an open-label prospective clinical study in seven very symptomatic patients who had not responded to any previous treatment, sibutramine achieved 94% suppression of syncopal episodes at 6 months.
“In an open-label prospective clinical study in seven very symptomatic patients who had not responded to any previous treatment, sibutramine achieved 94% suppression of syncopal episodes at 6 months. 289”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [289]
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2018 ESC Guidelines for the diagnosis and management of syncope
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- Authors
- SHELDON, R. S., RITCHIE, D., MCRAE, M., & RAJ, S.
- Affiliations
- Libin Cardiovascular Institute of Alberta (CA)
- Vanderbilt University (US)
- Corresponding author
- SHELDON, ROBERT S.
- Venue
- Journal of Cardiovascular Electrophysiology
- Publisher
- Wiley
- Published
- 2013-02-27
- Volume
- 24
- Issue
- 7
- Pages
- 799-803
- ISSN
- 1045-3873 (ISSN-L)
- 1540-8167
- OpenAlex
- W1495046225
- Cited by
- 22
- References
- 31
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 2 · 2023: 1 · 2022: 3 · 2021: 3 · 2020: 2 · 2019: 2 · 2018: 2 · 2016: 2 · 2014: 2 · 2013: 1
- FWCI
- 1.64
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Cardiovascular Electrophysiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Life Sciences › Neuroscience › Neurology › Vestibular and auditory disorders
- Keywords
- vasovagal syncope, norepinephrine reuptake inhibition, sibutramine, syncope prevention, syncope, dose-ranging
- MeSH terms
- Adult, Cyclobutanes, Female, Humans, Male, Middle Aged, Prospective Studies, Syncope, Vasovagal, Norepinephrine Plasma Membrane Transport Proteins
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