Serotonin reuptake inhibitor (Paxil) does not prevent the vasovagal reaction associated with carotid sinus massage and/or lower body negative pressure in healthy volunteers
Abstract
Background— The purpose of this study was to assess the effect of the serotonin reuptake inhibitor paroxetine hydrochloride (Paxil, SmithKline Beecham) on cardiovascular reflexes. We hypothesized that Paxil prevents neurally mediated syncope (NMS) by attenuating the sympathoinhibition and vagotonia associated with a vasovagal reaction. Methods and Results— In a double-blind randomized study, 25 healthy subjects with a positive response to either carotid sinus massage (CSM) or lower body negative pressure (LBNP) received Paxil (20 mg/d) or placebo for 6 weeks. Arterial baroreflex sensitivity (BRS), muscle sympathetic nerve activity (SNA), baroreflex control of SNA, blood pressure, and heart rate responses to CSM and LBNP were measured at baseline and at 6 weeks. Nineteen subjects completed the study (Paxil, n=9; placebo, n=10). In the Paxil group, BRS decreased significantly compared with baseline (15.8±4.0 ms/mm Hg versus 11.0±2.6 ms/mm Hg, P =0.05); however, all 9 subjects continued to have a positive response to LBNP with presyncope. Paxil did not attenuate the sympathoinhibition or vagotonia associated with a positive LBNP response and had no significant effect on baroreflex control of SNA. In the control group, no significant change in BRS was noted compared with baseline. Seven out of 9 subjects who had a positive LBNP response at baseline had a repeat positive LBNP response, and the subject with a positive CSM at baseline had a negative response at 6 weeks. Conclusions— Paxil decreases arterial BRS but does not prevent the presyncope associated with LBNP. The effect of Paxil on the autonomic reflexes in patients with neurally mediated syncope remains unclear.
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Based on this evidence, there have been several observational studies and three small randomized trials of serotonin transport inhibitors for prevention of vasovagal syncope.
“Based on this evidence, there have been several observational studies and 3 small, randomized trials on serotonin transport inhibitors for the prevention of vasovagal syncope.130–132”
From 2015 Heart Rhythm Society Expert Consensus Statement on the Diagnosis and Treatment of Postural Tachycardia Syndrome, Inappropriate Sinus Tachycardia, and Vasovagal Syncope (2015) · cites this paper as [131]
The Subjects’ Characteristics and Lower Body Negative Pressure sections describe a small randomized Paxil-versus-placebo trial. But the Present Study section says it tested provoked presyncope in healthy volunteers, not prevention of vasovagal syncope in patients; it also says the effect in patients with a history of syncope remains unknown. As one of three citations, this paper establishes the existence of this trial, not the total count. (LLM, conf=0.84)
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- Authors
- Takata, T. S., Wasmund, S. L., Smith, M. L., Li, J.-M., Joglar, J. A., Banks, K., Kowal, R. C., Page, R. L., & Hamdan, M. H.
- Affiliations
- University of North Texas Health Science Center (US)
- From the University of Texas Southwestern Medical Center and Dallas Veterans Affairs Medical Center (T.S.T., S.L.W., J.-M. L., J.A.J., K.B., R.C.K., R.L.P., M.H.H.), Dallas, Tex; and University of North Texas Health Science Center at Fort Worth, Department of Integrative Physiology (M.L.S.), Fort Worth, Tex.
- Venue
- Circulation
- Published
- 2002-09-17
- Volume
- 106
- Issue
- 12
- Pages
- 1500-1504
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2169805409
- Semantic Scholar
- 13ae720684535fbcb1ac46cc3585f203a23e20ee
- Cited by
- 57
- References
- 25
- Citations by year
- 2024: 1 · 2023: 3 · 2021: 2 · 2020: 1 · 2019: 2 · 2018: 3 · 2017: 9 · 2016: 3 · 2015: 3 · 2013: 1 · 2012: 3
- FWCI
- 2.86
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (R01 HL-65490-01)
- National Heart, Lung, and Blood Institute (R01 HL-65490-01, R01HL065490)
- 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 › Vagus Nerve Stimulation Research
- Keywords
- paroxetine, serotonin reuptake inhibitors, neurally mediated syncope, vasovagal reaction, carotid sinus massage, lower body negative pressure, baroreflex sensitivity, muscle sympathetic nerve activity, sympathoinhibition, vagotonia, autonomic reflexes, presyncope
- MeSH terms
- Animals, Blood Pressure, Carotid Sinus, Cats, Double-Blind Method, Female, Heart Rate, Humans, Lower Body Negative Pressure, Male, Massage, Sympathetic Nervous System, Selective Serotonin Reuptake Inhibitors, Paroxetine, Baroreflex, Syncope, Vasovagal, Rats
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