Autonomic Dysreflexia as a Potential Adverse Effect of Duloxetine and Amitriptyline Combination Therapy: A Case Report

PM&R ◽  
2019 ◽  
Vol 11 (2) ◽  
pp. 214-218 ◽  
Author(s):  
Sara C. Parke ◽  
Maria Regina Reyes
Keyword(s):  
Adverse Effect ◽  
Case Report ◽  
Combination Therapy ◽  
Autonomic Dysreflexia ◽  
Potential Adverse Effect

scholarly journals Paliperidone induced neutropenia in first episode psychosis: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Natalie Martos ◽  
William Hall ◽  
Alicia Marhefka ◽  
Thomas W. Sedlak ◽  
Frederick C. Nucifora
Keyword(s):  
Adverse Effect ◽  
Case Report ◽  
The United States ◽  
First Episode Psychosis ◽  
Potential Adverse Effect ◽  
Severe Neutropenia ◽  
First Episode ◽  
Antipsychotic Medications ◽  
Increased Risk ◽  
Episode Psychosis

Abstract Background Neutropenia, a decrease in total number of neutrophils below 1500/mm3 and particularly severe neutropenia, defined as neutrophils less than 500/mm3, is a potential adverse effect of antipsychotic medications that can lead to increased risk of infections and death. However, much of the attention on the potential adverse effect is centered exclusively on clozapine, which remains the only antipsychotic medication in the United States requiring standardized monitoring of blood work. We demonstrate here that paliperidone can also cause neutropenia and therefore clinicians should be aware of this possibility especially during initiation of treatment. Case presentation The following report presents the case of a 23-year-old African American male with first episode psychosis who developed neutropenia after initiation of paliperidone. Neutropenia resolved after discontinuation of paliperidone and initiation of an alternative antipsychotic, haloperidol. Conclusions This case report demonstrates an example of paliperidone induced neutropenia which resolved with a switch to haloperidol. We conclude that when initiating paliperidone, clinicians should be more aware of the risk of neutropenia. Moreover, neutropenia may be a more common and overlooked issue in patients on antipsychotic medications other than clozapine and increased awareness of comparative risk across antipsychotics could help direct treatment.

scholarly journals Combination therapy with prednisone and cyclophosphamide in a 14-year-old boy with pemphigus foliaceus – a case report

2017 ◽  
Vol 3 ◽  
pp. 324-330
Author(s):  
Magdalena Salińska ◽  
Kamil Trambowicz ◽  
Joanna Narbutt ◽  
Anna Woźniacka ◽  
Aleksandra Lesiak
Keyword(s):  
Case Report ◽  
Combination Therapy ◽  
Pemphigus Foliaceus

scholarly journals Dopamine agonist and tamoxifen combination therapy for a prolactin-secreting pituitary tumor resistant to dopamine agonist monotherapy: Case report and review

2020 ◽  
Vol 21 ◽  
pp. 100777
Author(s):  
Zachary K. Christian ◽  
Kimmo J. Hatanpaa ◽  
Richard J. Auchus ◽  
Stephen R. Hammes ◽  
Ankur R. Patel ◽  
...  
Keyword(s):  
Case Report ◽  
Combination Therapy ◽  
Dopamine Agonist ◽  
Pituitary Tumor

Extrapyramidal Symptoms with Ritonavir/Indinavir Plus Risperidone

2002 ◽  
Vol 36 (5) ◽  
pp. 827-830 ◽  
Author(s):  
Deborah V Kelly ◽  
Lizanne C Béïque ◽  
M Ian Bowmer
Keyword(s):  
Adverse Effect ◽  
Drug Interaction ◽  
Case Report ◽  
Vital Signs ◽  
Extrapyramidal Symptoms ◽  
Suspected Drug ◽  
Tic Disorder ◽  
Acute Dystonia ◽  
Active Moiety ◽  
Case Summary

OBJECTIVE: To report a case of suspected extrapyramidal symptoms (EPS) in a patient initiated on ritonavir and indinavir while taking risperidone for a tic disorder. CASE SUMMARY: A 35-year-old white man with AIDS received risperidone 2 mg twice daily for treatment of a Tourette's-like tic disorder. Ritonavir and indinavir were initiated, and 1 week later, he experienced significantly impaired swallowing, speaking, and breathing, and worsening of his existing tremors. Ritonavir and indinavir were discontinued. On the same day, the patient increased the risperidone dosage to 3 mg twice daily. Symptoms continued to worsen over the next 3 days. All investigations and laboratory parameters were unremarkable, and vital signs were stable. Risperidone was discontinued and clonazepam initiated. Three days later, the patient's symptoms were significantly improved. DISCUSSION: The symptoms described herein are consistent with neuroleptic-induced acute dystonia and potentially neuroleptic-induced parkinsonism. We believe this adverse effect occurred as a result of a drug interaction between ritonavir/indinavir and risperidone. Based on the pharmacokinetics of these medications, we hypothesize that inhibition of CYP2D6 and CYP3A4 by ritonavir and indinavir may have resulted in an accumulation of the active moiety of risperidone, which may explain the occurrence of EPS in this patient. CONCLUSIONS: This is the second published case report describing a suspected drug interaction with ritonavir, indinavir, and risperidone. Caution is warranted when risperidone is prescribed with ritonavir/indinavir, and possibly with other antiretrovirals that inhibit the same pathways.

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