Autonomic dysreflexia as a potential adverse effect of duloxetine and amitriptyline combination therapy: A case report

Pharmacologic triggers of autonomic dysreflexia (AD) have rarely been described. We present a 31 year-old woman with T3 AIS A spinal cord injury who developed recurrent AD while receiving duloxetine and amitriptyline combination therapy for neuropathic pain. After excluding other AD generators, duloxetine was discontinued and the AD episodes resolved. While secondary hypertension is a known side effect of amitriptyline and duloxetine, neither drug has been previously associated with AD. One potential mechanism for inhibition of duloxetine metabolism is discussed.

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