My 27 Year Old Son Was Diagnosed With A Chiari

Posted on Fri, 28 Feb 2020

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Fri, 28 Feb 2020 Answered on

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Question : My 27 year old son was diagnosed with a Chiari 1 malformation followed by decompression surgery. He has since developed POTS and Cardiomyopathy. He was placed on Amitriptyline for cyclic vomiting that now appears more related to the orthostatic tachycardia syndrome. With the heart condition and tachycardia his doctor wants him weaned from Amitriptyline 50 mg asap. He is 6'5 173 pounds and disabled physically by this illness. He can not afford side effects from withdrawal as well as the need to get off amitriptyline. What is the safest fastest approach to weaning him quickly without side effects. Thank you.

Answered by Dr. Bhanu Partap (7 hours later)

Brief Answer:
Need more details

Detailed Answer:
Hello

After going to the medical query raised by you I can very well understand your concern for your sons health and before proceeding further I would like to review his cardiac reports as well as his chiari malformation reports.

Kindly upload his echocardiography report as well as CT scan or MRI reports from your dashboard for review.

Kind Regards

Above answer was peer-reviewed by : Dr. Nagamani Ng

Follow up: Dr. Bhanu Partap (2 hours later)

Hi, I have provided some attachments. Please review them.

Follow up: Dr. Bhanu Partap (0 minute later)

Hi, I have provided some attachments. Please review them.

Answered by Dr. Bhanu Partap (3 hours later)

Brief Answer:
Hello again

Detailed Answer:
His latest echocardiogram is showing an ejection fraction of 50% which is an improvement over his last echocardiogram report which is good.

If amitriptyline Is started due to some psychological issue then it’s advisable to seek the help of a psychiatrist for proper way out otherwise it can be tapered over a period of couple of weeks by tapering the dose to avoid side effects of withdrawal.

Kind Regards

Above answer was peer-reviewed by : Dr. Nagamani Ng

Follow up: Dr. Bhanu Partap (7 hours later)

Thank you but the question was how to taper off amitriptyline 50 mg without causing side effects and doing it as quickly as possible. Thank you

Answered by Dr. Bhanu Partap (1 hour later)

Brief Answer:
Hello again

Detailed Answer:
The dose should be reduced to 25mg for a period of one week then 25 mg half tablet for another week and then stop.

Regards

Above answer was peer-reviewed by : Dr. Arnab Banerjee