A 34-year-old nurse in the U.K. took a common combination of medications for years, never suspecting the silent danger lurking in her daily routine. However, a recent coroner’s report revealed that a little-known, deadly drug interaction was responsible for her sudden cardiac arrest and death.
Chloé Burgess from Southampton, England, had been taking the antidepressants amitriptyline (a tricyclic antidepressant) and paroxetine (selective serotonin-reuptake inhibitors (SSRIs) before doctors prescribed her ivabradine. She was given ivabradine, a heart medication after being diagnosed with sinus tachycardia, which causes a rapid heartbeat, and left bundle branch block, a condition that disrupts the heart’s electrical signals.
A recent inquest into her unexplained death in 2023 revealed that her heart medication likely interacted with her antidepressant, causing elevated levels of amitriptyline in her blood. Burgess had been taking this combination for four years without issues. However, an episode of sleep apnea might have triggered severe cardiac arrhythmia and sudden cardiac death, the coroner’s report revealed.
“The potential dangers of the combination of amitriptyline, paroxetine and ivabradine is not widely appreciated and does not trigger an alert on the prescribing software used in primary care or by pharmacists,” Coroner Nicholas Walker said in the report.
Based on the inquest findings, the coroner has issued a stark warning to doctors and healthcare professionals, stressing the importance of having a “full understanding” of the potential risks when prescribing ivabradine alongside antidepressants.
“The potential dangers of the combination of drugs in Chloe’s case was not well-known or appreciated by those treating her…I am also concerned that those prescribing ivabradine should have a full understanding of the potential interaction with amitriptyline and paroxetine,” Walker said.
According to the Centers for Disease Control and Prevention (CDC), SSRIs are not suitable for everyone as they can cause problems if patients have other underlying conditions or when they are taken alongside other medicines.
SSRIs can pose risks for individuals with bleeding disorders, diabetes, epilepsy, narrow-angle glaucoma, or serious kidney, liver, or heart conditions. They may increase bleeding risk, affect blood sugar levels, and worsen seizures in epileptics.
Some medicines that can interact with SSRIs include non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and antiplatelets such as low-dose aspirin. Other interacting medications are theophylline, clozapine, lithium, triptans, and other antidepressants, including TCAs, MAOIs, and SNRIs.
