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.

A RARE CASE REPORT OF AMISULPRIDE INDUCED URINARY RETENTION

2021 ◽  
pp. 57-57
Author(s):  
G. Swetha ◽  
K. Mathan ◽  
S. Sri Sai Priya ◽  
R. Barath
Keyword(s):  
Adverse Effect ◽  
Case Report ◽  
Weight Gain ◽  
Adverse Effects ◽  
Urinary Retention ◽  
Atypical Antipsychotic ◽  
Rare Case ◽  
Extrapyramidal Symptoms ◽  
D3 Receptors ◽  
Rare Case Report

Amisulpride is an atypical antipsychotic with the preferential action on D2/D3 receptors. Its common adverse effects are extrapyramidal symptoms, insomnia, hyperkinesia, anxiety, weight gain, agitation, hyperprolactinemia. We have witnessed a adverse effect of urinary retention induced by amisulpride at minimal dosage and would like to present the same.

scholarly journals Flecainide toxicity associated with the use of goji berries: a case report

2021 ◽  
Vol 5 (6) ◽  
Author(s):  
Carlos E Guzmán ◽  
Carla Gabriela Guzmán-Moreno ◽  
José Luis Assad-Morell ◽  
Edgar Francisco Carrizales-Sepúlveda
Keyword(s):  
Emergency Department ◽  
Drug Interaction ◽  
Case Report ◽  
Cardiovascular Diseases ◽  
Herbal Remedies ◽  
Herbal Supplement ◽  
Case Summary ◽  
Goji Berries ◽  
Favourable Evolution ◽  
Chronic Cardiovascular Diseases

Abstract Background Goji berries (GB), usually marketed as a ‘superfruit’, are a widely used herbal supplement. As with other herbal remedies, the use of GB might be associated with herb–drug interactions, increasing plasma levels of other drugs and causing adverse events. Here, we present the case of a patient that developed flecainide toxicity secondary to an herb–drug interaction, associated with the use of GB to prevent COVID-19. Case summary A 75-year-old female presented to the emergency department with fainting. She was taking flecainide for the treatment of atrial extrasystoles diagnosed 2 years previously, and she was using a tea of GB for the prevention of COVID-19. The admission electrocardiogram showed a wide complex polymorphic tachycardia that was considered and treated as flecainide toxicity. The patient had a favourable evolution and was discharged 48 h after admission. Discussion Flecainide toxicity is uncommon and needs timely recognition and treatment; it is usually secondary to overdose and renal or hepatic failure. In our case, toxicity was associated with GB use, probably by inhibition of CYP2D6 which is the main enzyme associated with the metabolism of flecainide. Clinicians need to be aware of the possible interactions between herbal remedies (in this case used for the prevention of COVID-19) and cardiovascular drugs that are used to treat chronic cardiovascular diseases.

Recurrent Cholestasis Due to Ampicillin

2003 ◽  
Vol 37 (3) ◽  
pp. 395-397 ◽  
Author(s):  
Seyfettin Köklü ◽  
Osman Yüksel ◽  
Levent Filik ◽  
Oğuz Üsküdar ◽  
Kadri Altundağ ◽  
...  
Keyword(s):  
Adverse Effect ◽  
Adverse Drug Reaction ◽  
Drug Reaction ◽  
Case Report ◽  
Liver Injury ◽  
Literature Review ◽  
Causality Assessment ◽  
Single Case ◽  
Case Summary ◽  
One Year

OBJECTIVE: To present a single case of ampicillin-induced recurrent cholestasis and a literature review. CASE SUMMARY: A 23-year-old man was hospitalized due to recurrent and self-limited cholestatic symptoms. He had used ampicillin before each cholestatic attack. He became well clinically and biochemically each time after cessation of the drug. One year after his recovery and discontinuance of ampicillin, the patient has had no recurrence of cholestasis. An objective causality assessment revealed that the adverse drug reaction was probable. DISCUSSION: Ampicillin-related hepatotoxicity is very rare, with injury being mainly hepatocellular. To our knowledge, there is only 1 case report in the literature referring to chronic cholestatic-type hepatotoxicity related to ampicillin. CONCLUSIONS: Ampicillin, which is one of the most widely used antibiotics, may cause recurrent cholestatic hepatitis. Clinicians should be aware of this adverse effect, and it should be kept in mind during diagnostic workup of liver injury.

Hypersensitivity Reactions Associated with Parenteral Nutrition: Case Report and Review of the Literature

1993 ◽  
Vol 27 (2) ◽  
pp. 174-177 ◽  
Author(s):  
Marianne J. Nagata
Keyword(s):  
Adverse Effect ◽  
Case Report ◽  
Parenteral Nutrition ◽  
Lipid Emulsion ◽  
Case Reports ◽  
Hypersensitivity Reactions ◽  
Review Of The Literature ◽  
Allergy Testing ◽  
Case Summary ◽  
Multivitamin Preparation

Objective To report a case of a hypersensitivity reaction to total parenteral nutrition (TPN) and to review the available literature on this rare adverse effect. Case Summary The reaction occurred in a 52-year-old woman with pancreatic carcinoma who received intravenous metronidazole, tobramycin, vancomycin, ranitidine, morphine, TPN, and lipid emulsion postoperatively. Within 30 minutes of starting the TPN and lipid emulsion, the patient complained of dyspnea and pruritus. She began hyperventilating and was hypoxic. The reaction resolved after discontinuation of the TPN and lipid emulsion. The reaction recurred when lipid-free TPN was initiated on two subsequent occasions, and resolved spontaneously following the discontinuation of the lipid-free TPN. The antibiotics, ranitidine, and morphine therapy were continued with no further adverse effects and the patient was discharged on postoperative day 17. Discussion Case reports in the literature on TPN-related hypersensitivity reactions were reviewed. It was speculated that the multivitamin preparation (MVI) may have been the causative agent in our patient; however, this was not confirmed by MVI-free TPN administration or by epicutaneous allergy testing. Conclusions Hypersensitivity reactions to TPN can be managed by withholding the TPN and treating with antihistamines if needed until the reaction resolves. Identification, possibly by epicutaneous allergy testing, and removal of the offending agent(s) from the TPN is necessary if TPN therapy must be restarted.

Fluoxetine and Tics in an Adolescent

1993 ◽  
Vol 27 (6) ◽  
pp. 725-726 ◽  
Author(s):  
Gail Eisenhauer ◽  
Donna M. Jermain
Keyword(s):  
Case Report ◽  
Reuptake Inhibitor ◽  
Dopaminergic Neurons ◽  
Serotonin Reuptake ◽  
Adverse Reactions ◽  
Extrapyramidal Symptoms ◽  
Case Summary ◽  
Depressed Adolescent ◽  
Pharmacologic Agents ◽  
Fluoxetine Therapy

OBJECTIVE: To describe a case of tics associated with fluoxetine. CASE SUMMARY: A depressed adolescent was treated with fluoxetine. The patient had not been exposed to any other pharmacologic agents prior to this treatment. Following eight months of fluoxetine therapy the patient developed numerous tics. The movements subsided six months after discontinuation of fluoxetine. DISCUSSION: Antidopaminergic effects have been reported in patients treated with fluoxetine. Because fluoxetine is a specific serotonin reuptake inhibitor, one plausible explanation for the extrapyramidal symptoms observed in these patients is that serotonin modulates dopaminergic neurons. CONCLUSIONS: Extrapyramidal symptoms have been reported in patients receiving fluoxetine, although never previously in an adolescent. This case report provides further evidence that fluoxetine may be associated with severe extrapyramidal adverse reactions.

Pseudo-Parkinson Disease Secondary to Ritonavir–Buspirone Interaction

2003 ◽  
Vol 37 (2) ◽  
pp. 202-205 ◽  
Author(s):  
Patrick G Clay ◽  
Molly M Adams
Keyword(s):  
Drug Interaction ◽  
Inhibitory Effect ◽  
Hiv Positive ◽  
High Dose ◽  
Resting Tremor ◽  
Case Summary ◽  
History Of ◽  
Drug Drug Interaction ◽  
To Receive

OBJECTIVE: To report a case of Parkinson-like symptoms appearing in a patient after introduction of ritonavir to buspirone therapy. CASE SUMMARY: A 54-year-old HIV-positive white man presented to the clinic with a 2-week history of ataxia, shuffling gait, cogwheel rigidity, resting tremor, and sad affect with masked features. This patient had been receiving high-dose buspirone (40 mg every morning and 30 mg every evening) for 2 years prior to the introduction of ritonavir/indinavir combination therapy (400 mg/400 mg twice daily) 6 weeks prior to initiation of the above symptoms. Buspirone was decreased to 15 mg 3 times daily, ritonavir/indinavir was discontinued, and amprenavir 1200 mg twice daily was added. The patient's symptoms began to subside after 1 week, with complete resolution after about 2 weeks. The patient continued to receive buspirone for an additional 12 months without recurrence of symptoms. DISCUSSION: This is the first reported interaction of buspirone and antiretrovirals. Buspirone, extensively metabolized by CYP3A4, was likely at supratherapeutic levels due to the inhibitory effect of ritonavir and, secondarily, indinavir. The Parkinson-like symptoms developed rapidly and severely, impacted this patient's quality of life, and necessitated significant clinic expenditures to identify this drug–drug interaction. CONCLUSIONS: This case demonstrates a severe drug–drug interaction between buspirone and ritonavir and further demonstrates the need for awareness of the metabolic profile for all agents an HIV-infected patient is receiving.

scholarly journals Palisaded neutrophilic and granulomatous dermatitis following a long-standing monoclonal gammopathy: A case report

2021 ◽  
Vol 9 ◽  
pp. 2050313X2097956
Author(s):  
Dorsa Zabihi-pour ◽  
Bahar Bahrani ◽  
Dalal Assaad ◽  
Jensen Yeung
Keyword(s):  
Rheumatoid Arthritis ◽  
Case Report ◽  
Connective Tissue ◽  
Monoclonal Gammopathy ◽  
Inflammatory Dermatosis ◽  
Case Summary ◽  
Underlying Causes ◽  
Granulomatous Dermatitis ◽  
Skin Biopsies ◽  
Underlying Diseases

Background: Palisaded neutrophilic granulomatous dermatitis is a rare inflammatory dermatosis with possible underlying systemic conditions including rheumatoid arthritis, autoimmune connective tissue disease, and malignancies. Case Summary: We report a case of an 84-year-old man presenting with a 3-week eruption of asymptomatic annular plaques on his neck, which progressed to involve his back and legs. Skin biopsies confirmed a diagnosis of palisaded neutrophilic granulomatous dermatitis, and he was treated with prednisone. Full workup related to potential underlying causes of palisaded neutrophilic granulomatous dermatitis was completed. Conclusion: Palisaded neutrophilic granulomatous dermatitis may precede the onset of underlying systemic conditions or occur concomitantly. Following the diagnosis, clinicians should perform a comprehensive focused history, physical examination, and laboratory investigation related to the associated underlying diseases.

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 Herb–Drug Interactions: Worlds Intersect with the Patient at the Center

Medicines ◽  
2021 ◽  
Vol 8 (8) ◽  
pp. 44
Author(s):  
Mary Beth Babos ◽  
Michelle Heinan ◽  
Linda Redmond ◽  
Fareeha Moiz ◽  
Joao Victor Souza-Peres ◽  
...  
Keyword(s):  
Drug Interaction ◽  
Case Report ◽  
Drug Interactions ◽  
Clinical Studies ◽  
Drug Information ◽  
Case Reports ◽  
Full Information ◽  
Information Need ◽  
Herbal Products ◽  
Reduce Risk

This review examines three bodies of literature related to herb–drug interactions: case reports, clinical studies, evaluations found in six drug interaction checking resources. The aim of the study is to examine the congruity of resources and to assess the degree to which case reports signal for further study. A qualitative review of case reports seeks to determine needs and perspectives of case report authors. Methods: Systematic search of Medline identified clinical studies and case reports of interacting herb–drug combinations. Interacting herb–drug pairs were searched in six drug interaction resources. Case reports were analyzed qualitatively for completeness and to identify underlying themes. Results: Ninety-nine case-report documents detailed 107 cases. Sixty-five clinical studies evaluated 93 mechanisms of interaction relevant to herbs reported in case studies, involving 30 different herbal products; 52.7% of these investigations offered evidence supporting reported reactions. Cohen’s kappa found no agreement between any interaction checker and case report corpus. Case reports often lacked full information. Need for further information, attitudes about herbs and herb use, and strategies to reduce risk from interaction were three primary themes in the case report corpus. Conclusions: Reliable herb–drug information is needed, including open and respectful discussion with patients.

Necrotizing Fasciitis Occurred in the Lymphedematous leg

2021 ◽  
pp. 153473462110230
Author(s):  
Hisako Hara ◽  
Makoto Mihara ◽  
Takeshi Todokoro
Keyword(s):  
Case Report ◽  
Necrotizing Fasciitis ◽  
Lower Limb ◽  
Gynecologic Cancer ◽  
Vital Signs ◽  
Ethics Committee ◽  
Secondary Lymphedema ◽  
Delayed Treatment ◽  
Institutional Ethics ◽  
Life Threatening

Lymphedema is a chronic edema that sometimes occurs after treatment of gynecologic cancer, and cellulitis often occurs concomitantly with lymphedema. On the other hand, necrotizing fasciitis (NF) is a relatively rare, but life-threatening disease. The symptoms in cellulitis and NF are very similar. In this case report, we describe a case in which the diagnosis of NF in a lymphedematous limb was difficult. A 70-year-old woman had secondary lymphedema in bilateral legs and consulted our department. On the first day of lymphedema therapy, the patient complained of vomiting, diarrhea, and fever (37.7 °C) without local fever in the legs. She was diagnosed with acute gastroenteritis. On the next day, swelling and pain in her left leg occurred and her blood pressure was 59/44 mmHg. She was diagnosed with cellulitis accompanied by lower limb lymphedema and septic shock. On the second day, blisters appeared on the left leg, and computed tomography showed NF. We performed debridement under general anesthesia and her vital signs improved postoperatively. Streptococcus agalactiae (B) was detected in blood culture, and we administered bixillin and clindamycin. Postoperatively, necrosis in the skin and fat around the left ankle gradually spread, and it took 5 months to complete epithelialization. The diagnosis was more difficult than usual NF because patients with lymphedema often experience cellulitis. Clinicians should always think of NF to avoid mortality due to delayed treatment. This case report was approved by the institutional ethics committee.

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