a-t 2017; 48: 39

ANISOCORIA WITH ESCITALOPRAM (CIPRALEX, GENERICS)

The selective serotonin reuptake inhibitor (SSRI) escitalopram (CIPRALEX, generics) was reinstated for a 17 year-old female patient after a treatment-free interval of approximately one year. After taking the medication for several days, the patient developed pupils of unequal size. They reverted to normal size three days after discontinuing the antidepressant (NETZWERK report 17.253). Reports of the onset of anisocoria during treatment with the SSRIs escitalopram, paroxetine (SEROXAT, generics) and sertraline (ZOLOFT, generics) have been published (1-3). To date, the WHO has documented 63 reports of pupils of unequal size in conjunction with SSRIs and 27 with serotonin noradrenaline re-uptake inhibitors (SNRIs) such as venlafaxine (TREVILOR, generics) (4).* Mydriasis, the symmetrical dilatation of both pupils is considered as a group effect of the SSRIs and caution should, therefore, be exercised when prescribing this group of substances for persons with a history of narrow-angle glaucoma or glaucoma. However, anisocoria has, to our knowledge, only been reported in the summary of product characteristics (SPC) for sertraline (5). Unilateral dilatation or constriction of the pupil is generally indicative of neurological or ophthalmological disease. If a medicinal cause is also considered, further diagnostic measures and unnecessary worry of patients may be avoided, if applicable.

  1 YUCEL, A. et al.: J. Clin. Psychopharmacol. 2015; 35: 483-4
  2 BARRETT, J.: BMJ 1994; 309: 1620
  3 FALAVIGNA, A. et al.: J. Clin. Psychopharmacol. 2010; 30: 646-7
  4 WHO database, accessed Apr. 2017; http://www.vigiaccess.org
  5 e.g. Pfizer: SPC ZOLOFT, as at June 2016

  * The reports refer to all active substances commercially available in Germany except for the SSRI, dapoxetine, which is authorised only for men with premature ejaculation (PRILIGY; a-t 2009; 40: 54-6).

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