If facing possible drug interactions, search for alternative meds

Dear Dr. Roach • I am writing about a concerning development with my 67-year-old husband. After more than a year of taking a 10 mg dose of escitalopram, his internist increased the dose to 20 mg. This vastly improved his depression symptoms over the past year. For many years, he has taken flecainide for atrial fibrillation.

In early December, a nurse from his cardiologist’s office called, concerned about possible interaction between escitalopram and flecainide. I told her that he had taken escitalopram for a long time with no problems. However, during his subsequent office visit, the cardiologist persuaded him to stop taking escitalopram.

These are my concerns: It doesn’t seem like a good idea to stop taking the depression medication cold turkey. There was no attempt by the doctor to find possible alternatives. My husband’s depression symptoms have come roaring back, greatly impacting his behavior. Any thoughts on where to go with this? â€" R.R.

Answer • Flecainide is an anti-arrhythmic drug that does have the potential for toxicity and drug interactions. With escitalopram, a commonly used antidepressant, the concern is for a potential for heart toxicity from a type of finding on the electrocardiogram called a long QT, which can predispose someone to a life-threatening rhythm disturbance far worse than the atrial fibrillation, called torsade de pointes. If your husband had a long QT when on the higher dose of escitalopram and flecainide, stopping one of the two medications is the prudent thing to do. If the QT was not prolonged, I don’t think either medicine needed to be stopped or changed.