Why should duloxetine be avoided in people with stiff person syndrome?

Serotonin-norepinephrine reuptake inhibitors may exacerbate stiff person syndrome

Benavides DR, Newsome SD.

Neurol Neuroimmunol Neuroinflamm 2016; 3:e281.

Stiff-person syndrome (SPS) is a neuroimmunologic disorder characterized by painful spasms and muscle rigidity attributed to impaired inhibitory γ-aminobutyric acid (GABA) descending pathways.The immunopathogenesis remains unknown and the pathogenic significance of antibodies against glutamic acid decarboxylase (GAD) is controversial.

Herein, we report 4 cases of anti-GAD65-positive patients with SPS  who had significant worsening of symptoms and disability with the serotonin-norepinephrine reuptake inhibitor (SNRI) duloxetine. While causation cannot be proven, these observations suggest the importance of investigating the relationship between SNRI use and SPS clinical exacerbations.

This reference is now included in the neurochecklist:

Stiff person syndrome (SPS): clinical features

By Fuse809 (talk) - Own work, Public Domain, Link
By Fuse809 (talk) – Own work, Public Domain, Link



5 thoughts on “Why should duloxetine be avoided in people with stiff person syndrome?

  1. Another possible cautionary tale. Following a groundbreaking article in the New England Journal of Medicine, intravenous immune globulin is sometimes used. See High Dose Intravenous Immune Globulin for Stiff Person Syndrome, New Engl J Med, Vol. 345, No. 26 · December 27, 2001 · While reporting some impressive results, that study indicated that response was relatively quick. (distribution-of-stiffness scores but decreased significantly during the three months of immune globulin therapy). Some patients benefited within a month.

    The etiology of this disease still has many puzzles. Anecdotally it appears some doctors are increasing dosage when there is little or no response but the New England Journal study does not seem to support that approach. I did not see patients who failed to respond but then benefited from increased dosage many months down the line. The immune globulin does appear to have side effects.


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