Doctors were today told to stop dishing out three common drugs given to thousands of Brits at the same time, over fears the combination could cause ‘sudden death’. The warning follows the death of a ‘beautiful, generous and caring’ nurse, who died of a sudden cardiac arrest four years after starting the medications.  Chloé Burgess, from Southampton, was already taking two common antidepressants in 2019 when she was prescribed ivabradine — sold under the brand name Procoralan — to treat an abnormal heart rhythm.

Yet, the dangers of this combination of drugs was not well known among health workers who treated her, a coroner has concluded.  Amitriptyline, a tricyclic antidepressant (TCA) sold as Elavil, is one of the three medications coroner Nicholas Walker raised the alarm over.  The NHS already warns that TCAs can cause serious cardiovascular problems and should be avoided in patients with heart conditions.  The other, the SSRI paroxetine sold as Seroxat, is advised against for patients who have heart problems given it can trigger irregular heart beats.  In a Prevention of Future Deaths report, however, Mr Walker wrote: ‘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.’

Chloe Burgess, from Southampton, was already taking two common antidepressants in 2019 before she was prescribed ivabradine — sold under the brand name Procoralan — to treat an abnormal heart rate

Amitriptyline, a tricyclic antidepressant (TCA) sold as Elavil, is one of the three medications Nicholas Walker raised the alarm over ‘She had been using the combination of drugs for four years before she died without concern.  ‘The potential dangers of the combination of drugs in Chloe’s case was not well-known or appreciated by those treating her.’

Ms Burgess was prescribed the heart medication after she was diagnosed with sinus tachycardia — when the heart rate is faster than normal — and a left bundle branch block, a disruption to the electrical impulse that cause the heart to beat.  But the medications likely interacted with each other to raise the levels of the amitriptyline medication in her blood, Mr Walker noted.  An episode of sleep apnoea, when breathing stops and starts while sleeping, then induced ‘severe cardiac arrhythmia and sudden cardiac death’.  Health professionals prescribing ivabradine must have a ‘full understanding’ of how they could interact with amitriptyline and paroxetine, he urged.  A copy of his report was also sent to UK medicines spending watchdog the National Institute for Health and Care Excellence (NICE), the British National Formulary (BNF), as well as the Royal College of Physicians. All three organisations ‘have the power’ to ‘prevent future deaths’, Mr Walker warned.

The other antidepressant, paroxetine sold as Seroxat, advised against for patients who have heart problems given it can trigger irregular heart beats

Ms Burgess was prescribed Procoralan after she was diagnosed with sinus tachycardia — when the heart rate is faster than normal but the heart beats regularly — and left bundle branch block, a disruption to the electrical impulse that cause the heart to beat. The health service has long advised that antidepressants can react unpredictably with other medicines, including some over-the-counter medicines such as ibuprofen. As a precaution they are not often recommended in children or among pregnant women — especially during the early stages of pregnancy.  TCAs, an older type of antidepressant, are also not often recommended as a first treatment for depression given they often cause more unpleasant side effects than others including SSRIs and have a higher risk of toxicity and overdose.  The warning following Ms Burgess’ death also comes just weeks after another coroner warned that the lack of ‘communication between primary and secondary care’ may lead to the ‘early death’ of more patients. Susan Ridge said patient Tammy Milward died of ‘mixed drug toxicity’, despite multiple warning messages that were sent to her GP and NHS trust.