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Sweileh WM. Neuroleptic malignant syndrome and serotonin syndrome: a comparative bibliometric analysis. Orphanet J Rare Dis 2024; 19:221. [PMID: 38825678 PMCID: PMC11145872 DOI: 10.1186/s13023-024-03227-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 05/27/2024] [Indexed: 06/04/2024] Open
Abstract
OBJECTIVE This study aimed to analyze and map scientific literature on Neuroleptic Malignant Syndrome (NMS) and Serotonin Syndrome (SS) from prestigious, internationally indexed journals. The objective was to identify key topics, impactful articles, prominent journals, research output, growth patterns, hotspots, and leading countries in the field, providing valuable insights for scholars, medical students, and international funding agencies. METHODS A systematic search strategy was implemented in the PubMed MeSH database using specific keywords for NMS and SS. The search was conducted in the Scopus database, renowned for its extensive coverage of scholarly publications. Inclusion criteria comprised articles published from 1950 to December 31st, 2022, restricted to journal research and review articles written in English. Data were analyzed using Microsoft Excel for descriptive analysis, and VOSviewer was employed for bibliometric mapping. RESULTS The search yielded 1150 articles on NMS and 587 on SS, with the majority being case reports. Growth patterns revealed a surge in NMS research between 1981 and 1991, while SS research increased notably between 1993 and 1997. Active countries and journals differed between NMS and SS, with psychiatry journals predominating for NMS and pharmacology/toxicology journals for SS. Authorship analysis indicated higher multi-authored articles for NMS. Top impactful articles focused on review articles and pathogenic mechanisms. Research hotspots included antipsychotics and catatonia for NMS, while SS highlighted drug interactions and specific medications like linezolid and tramadol. CONCLUSIONS NMS and SS represent rare but life-threatening conditions, requiring detailed clinical and scientific understanding. Differential diagnosis and management necessitate caution in prescribing medications affecting central serotonin or dopamine systems, with awareness of potential drug interactions. International diagnostic tools and genetic screening tests may aid in safe diagnosis and prevention. Reporting rare cases and utilizing bibliometric analysis enhance knowledge dissemination and research exploration in the field of rare drug-induced medical conditions.
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Affiliation(s)
- Waleed M Sweileh
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.
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2
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Parkhomenko AA, Zastrozhin MS, Skryabin VY, Petukhov AE, Pozdniakov SA, Ivanchenko VA, Zaytsev IA, Bure IV, Bochkov PO, Akmalova KA, Smirnov VV, Bryun EA, Sychev DA. Relationship of CYP3A4*1B Single Nucleotide Polymorphism to the Efficiency and Safety Profiles of Haloperidol in Patients Enduring Acute Alcoholic Hallucinosis. PSYCHOPHARMACOLOGY BULLETIN 2023; 53:8-14. [PMID: 38076668 PMCID: PMC10698852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
To date, haloperidol has been widely used to treat patients with acute alcoholic hallucinosis. There is strong evidence that haloperidol therapy is commonly associated with adverse drug reactions (ADRs). The 392A > G polymorphism of the CYP3A4*1B gene (rs2740574) is known to affect the metabolism rates of haloperidol; hence it correlates with both therapy efficacy and safety parameters. Objective The study objective was to investigate the effect of 392A > G polymorphism of the CYP3A4*1B gene (rs2740574) on the efficacy and safety profiles of haloperidol in patients with acute alcoholic hallucinosis. Methods This study enrolled 100 male patients suffering from acute alcoholic hallucinosis (mean age 41.4 ± 14.4 years). The efficacy profile of haloperidol was assessed using the PANSS (Positive and Negative Syndrome Scale) validated psychometric scale. The safety profile of therapy was assessed with the UKU Side-Effect Rating Scale and the SAS (Simpson-Angus Scale for Extrapyramidal Symptoms) scale. Genotyping was performed using the real-time polymerase chain reaction (Real-time PCR). Results There were no statistically significant results for the efficacy rates (dynamics of the PANSS score: AA genotype -14.00 [-16.00; -12.00], AG genotype -13.00 [-14.00; -10.50], p = 0.306). Similarly, there was no statistically significant difference in the safety profiles (dynamics of the UKU score: AA genotype - 9.00 [7.00; 13.00], AG genotype - 8.50 [7.25; 10.50], p = 0.620; dynamics of the SAS score: AA genotype -12.00 [10.00; 16.75], AG genotype - 10.00 [10.00; 12.25], p = 0.321). Conclusion The study demonstrated that the 392A > G polymorphism of the CYP3A4*1B gene (rs2740574) in patients with acute alcoholic hallucinosis does not affect the efficacy and safety rates of haloperidol therapy.
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Affiliation(s)
- A A Parkhomenko
- Parkhomenko, postgraduate student at the Department of Addiction Medicine, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - M S Zastrozhin
- Zastrozhin, PhD, MD, Associate professor of addiction psychiatry department
| | - VYu Skryabin
- Skryabin, PhD, MD, head of clinical department; Associate professor of addiction psychiatry department
| | - A E Petukhov
- Petukhov, PhD, MD, clinical laboratory diagnostician of the analytical toxicology lab of the Reference center for psychoactive substances use monitoring; associate professor of pharmaceutical and toxicological chemistry, Moscow, Russia
| | - S A Pozdniakov
- Pozdniakov, researcher of the laboratory of genetics and fundamental studies
| | - V A Ivanchenko
- Ivanchenko, laboratory assistant, Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia
| | - I A Zaytsev
- Zaytsev, laboratory assistant, Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia
| | - I V Bure
- Bure, Senior Researcher, Predictive and Prognostic Biomarkers Department, Research Institute of Molecular and Personalized Medicine
| | - P O Bochkov
- Bochkov, Senior Researcher, Predictive and Prognostic Biomarkers Department, Research Institute of Molecular and Personalized Medicine
| | - K A Akmalova
- Akmalova, Researcher at the Department of Predictive and Prognostic Biomarkers of the Research Institute of Molecular and Personalized Medicine
| | - V V Smirnov
- Smirnov, Dr. Pharm. Sc, Head of the scientific and production complex FGBU "SSC Institute of Immunology" FMBA of Russia, National Research Center-Institute of Immunology Federal Medical-Biological Agency of Russia, Moscow, Russian Federation
| | - E A Bryun
- Bryun, PhD, MD, professor, president, head of addiction psychiatry department
| | - D A Sychev
- Sychev, corresponding member of the Academy of Sciences of Russia, MD, PhD, professor, rector, head of clinical pharmacology and therapy department, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
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Merino D, Fernandez A, Gérard AO, Ben Othman N, Rocher F, Askenazy F, Verstuyft C, Drici MD, Thümmler S. Adverse Drug Reactions of Olanzapine, Clozapine and Loxapine in Children and Youth: A Systematic Pharmacogenetic Review. Pharmaceuticals (Basel) 2022; 15:ph15060749. [PMID: 35745668 PMCID: PMC9230864 DOI: 10.3390/ph15060749] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/08/2022] [Accepted: 06/10/2022] [Indexed: 01/27/2023] Open
Abstract
Children and youth treated with antipsychotic drugs (APs) are particularly vulnerable to adverse drug reactions (ADRs) and prone to poor treatment response. In particular, interindividual variations in drug exposure can result from differential metabolism of APs by cytochromes, subject to genetic polymorphism. CYP1A2 is pivotal in the metabolism of the APs olanzapine, clozapine, and loxapine, whose safety profile warrants caution. We aimed to shed some light on the pharmacogenetic profiles possibly associated with these drugs’ ADRs and loss of efficacy in children and youth. We conducted a systematic review relying on four databases, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 recommendations and checklist, with a quality assessment. Our research yielded 32 publications. The most frequent ADRs were weight gain and metabolic syndrome (18; 56.3%), followed by lack of therapeutic effect (8; 25%) and neurological ADRs (7; 21.8%). The overall mean quality score was 11.3/24 (±2.7). In 11 studies (34.3%), genotyping focused on the study of cytochromes. Findings regarding possible associations were sometimes conflicting. Nonetheless, cases of major clinical improvement were fostered by genotyping. Yet, CYP1A2 remains poorly investigated. Further studies are required to improve the assessment of the risk–benefit balance of prescription for children and youth treated with olanzapine, clozapine, and/or loxapine.
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Affiliation(s)
- Diane Merino
- Department of Child and Adolescent Psychiatry, Children’s Hospitals of Nice CHU-Lenval, 06200 Nice, France; (D.M.); (A.F.); (F.A.)
- CoBTek Laboratory, Université Côte d’Azur, 06100 Nice, France
- Department of Pharmacology and Pharmacovigilance Center, University Hospital of Nice, 06000 Nice, France; (A.O.G.); (N.B.O.); (F.R.); (M.-D.D.)
| | - Arnaud Fernandez
- Department of Child and Adolescent Psychiatry, Children’s Hospitals of Nice CHU-Lenval, 06200 Nice, France; (D.M.); (A.F.); (F.A.)
- CoBTek Laboratory, Université Côte d’Azur, 06100 Nice, France
| | - Alexandre O. Gérard
- Department of Pharmacology and Pharmacovigilance Center, University Hospital of Nice, 06000 Nice, France; (A.O.G.); (N.B.O.); (F.R.); (M.-D.D.)
| | - Nouha Ben Othman
- Department of Pharmacology and Pharmacovigilance Center, University Hospital of Nice, 06000 Nice, France; (A.O.G.); (N.B.O.); (F.R.); (M.-D.D.)
| | - Fanny Rocher
- Department of Pharmacology and Pharmacovigilance Center, University Hospital of Nice, 06000 Nice, France; (A.O.G.); (N.B.O.); (F.R.); (M.-D.D.)
| | - Florence Askenazy
- Department of Child and Adolescent Psychiatry, Children’s Hospitals of Nice CHU-Lenval, 06200 Nice, France; (D.M.); (A.F.); (F.A.)
- CoBTek Laboratory, Université Côte d’Azur, 06100 Nice, France
| | - Céline Verstuyft
- Service de Génétique Moléculaire, Pharmacogénétique et Hormonologie, Hôpital Bicêtre, Groupe Hospitalier Paris Saclay, AP–HP, 94270 Le Kremlin-Bicêtre, France;
- CESP/UMR-S1178, Inserm, Université Paris-Sud, 92290 Paris, France
| | - Milou-Daniel Drici
- Department of Pharmacology and Pharmacovigilance Center, University Hospital of Nice, 06000 Nice, France; (A.O.G.); (N.B.O.); (F.R.); (M.-D.D.)
| | - Susanne Thümmler
- Department of Child and Adolescent Psychiatry, Children’s Hospitals of Nice CHU-Lenval, 06200 Nice, France; (D.M.); (A.F.); (F.A.)
- CoBTek Laboratory, Université Côte d’Azur, 06100 Nice, France
- Correspondence:
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Kawataki M, Nakanishi Y, Yokoyama T, Ishida T. Hypothyroidism as an immune-related adverse event caused by atezolizumab in a patient with muscle spasms: a case report. Respir Med Case Rep 2022; 36:101585. [PMID: 35116222 PMCID: PMC8792264 DOI: 10.1016/j.rmcr.2022.101585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/12/2022] [Accepted: 01/12/2022] [Indexed: 11/10/2022] Open
Abstract
A 60-year-old man with a history of 4 cycles of atezolizumab treatment for non-small cell lung cancer presented to our hospital with a chief complaint of proximal muscle-dominant spasms. Blood tests showed elevated creatine phosphokinase (CPK) of 8450 U/L and hypothyroidism. There was little improvement even after stopping levetiracetam and pregabalin, and no subspinous physical findings of myositis. After levothyroxine was started for hypothyroidism, his muscle cramps and serum CPK level improved. Hypothyroidism as an immune-related adverse event can cause muscle spasms and is important in the differential diagnosis of muscle spasms in patients treated with immune checkpoint inhibitors.
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Munafò A, Frara S, Perico N, Di Mauro R, Cortinovis M, Burgaletto C, Cantarella G, Remuzzi G, Giustina A, Bernardini R. In search of an ideal drug for safer treatment of obesity: The false promise of pseudoephedrine. Rev Endocr Metab Disord 2021; 22:1013-1025. [PMID: 33945051 PMCID: PMC8724077 DOI: 10.1007/s11154-021-09658-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/27/2021] [Indexed: 12/14/2022]
Abstract
Obesity is a major public health problem worldwide. Only relatively few treatment options are, at present, available for the management of obese patients. Furthermore, treatment of obesity is affected by the widespread misuse of drugs and food supplements. Ephedra sinica is an old medicinal herb, commonly used in the treatment of respiratory tract diseases. Ephedra species contain several alkaloids, including pseudoephedrine, notably endowed with indirect sympathomimetic pharmacodynamic properties. The anorexigenic effect of pseudoephedrine is attributable primarily to the inhibition of neurons located in the hypothalamic paraventricular nucleus (PVN), mediating satiety stimuli. Pseudoephedrine influences lipolysis and thermogenesis through interaction with β3 adrenergic receptors and reduces fat accumulation through down-regulation of transcription factors related to lipogenesis. However, its use is associated with adverse events that involve to a large extent the cardiovascular and the central nervous system. Adverse events of pseudoephedrine also affect the eye, the intestine, and the skin, and, of relevance, sudden cardiovascular death related to dietary supplements containing Ephedra alkaloids has also been reported. In light of the limited availability of clinical data on pseudoephedrine in obesity, along with its significantly unbalanced risk/benefit profile, as well as of the psychophysical susceptibility of obese patients, it appears reasonable to preclude the prescription of pseudoephedrine in obese patients of any order and degree.
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Affiliation(s)
- Antonio Munafò
- Department of Biomedical and Biotechnological Sciences, University of Catania School of Medicine, Catania, Italy
| | - Stefano Frara
- Institute of Endocrine and Metabolic Sciences (IEMS), San Raffaele Vita-Salute University, Milano, Milano, Italy
| | - Norberto Perico
- Istituto Di Ricerche Farmacologiche "Mario Negri", Bergamo, Italy
| | - Rosaria Di Mauro
- Department of Biomedical and Biotechnological Sciences, University of Catania School of Medicine, Catania, Italy
| | | | - Chiara Burgaletto
- Department of Biomedical and Biotechnological Sciences, University of Catania School of Medicine, Catania, Italy
| | - Giuseppina Cantarella
- Department of Biomedical and Biotechnological Sciences, University of Catania School of Medicine, Catania, Italy
| | - Giuseppe Remuzzi
- Istituto Di Ricerche Farmacologiche "Mario Negri", Bergamo, Italy
| | - Andrea Giustina
- Institute of Endocrine and Metabolic Sciences (IEMS), San Raffaele Vita-Salute University, Milano, Milano, Italy
| | - Renato Bernardini
- Department of Biomedical and Biotechnological Sciences, University of Catania School of Medicine, Catania, Italy.
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León-Amenero D, Huarcaya-Victoria J. Neuroleptic malignant syndrome in children and adolescents: Systematic review of case reports. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2021; 50:290-300. [PMID: 34742696 DOI: 10.1016/j.rcpeng.2019.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 10/28/2019] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Neuroleptic malignant syndrome (NMS) is a rare and potentially fatal drug adverse reaction. There are still few studies of this entity in the child-adolescent population. OBJECTIVES Describe the clinical, laboratory and therapeutic characteristics of children and adolescent patients with NMS. Analyse the grouping of symptoms present in NMS in the same population. MATERIAL AND METHODS A MEDLINE/PubMed search of all reported cases of NMS from January 2000 to November 2018 was performed and demographic, clinical, laboratory and therapeutic variables were identified. A factorial analysis of the symptoms was performed. RESULTS 57 patients (42 males and 15 females) were included, (mean age 13.65 ± 3.89 years). The onset of NMS occurred at 11.25 ± 20.27 days with typical antipsychotics and at 13.69 ± 22.43 days with atypical antipsychotics. The most common symptoms were muscle stiffness (84.2%), autonomic instability (84.2%) and fever (78.9). The most common laboratory findings were CPK elevation and leucocytosis (42.1%). The most used treatment was benzodiazepines (28.1%). In the exploratory factorial analysis of the symptoms we found 3 factors: 1) "Catatonic" with mutism (0.912), negativism (0.825) and waxy flexibility (0.522); 2) "Extrapyramidal" with altered gait (0.860), involuntary abnormal movements (0.605), muscle stiffness (0.534) and sialorrhoea (0.430); and 3) "Autonomic instability" with fever (0.798), impaired consciousness (0.795) and autonomic instability (0.387). CONCLUSIONS NMS in children and adolescents could be of 3 types: catatonic, extrapyramidal and autonomic unstable.
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Affiliation(s)
- Deborah León-Amenero
- Médico psiquiatría de niños y adolescentes, Servicio de Psiquiatría Infanto-juvenil, Departamento de Psiquiatría, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
| | - Jeff Huarcaya-Victoria
- Universidad de San Martín de Porres, Facultad de Medicina, Centro de Investigación en Salud Pública, Lima, Peru; Médico psiquiatra, Servicio de Psiquiatría General, Departamento de Psiquiatría, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru.
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David A, Fernandez A, Menard ML, Dor E, Leali G, Maria F, Cruzel C, Askenazy F, Verstuyft C, Thümmler S. [Pharmacoresistance to psychotropic drugs in children and adolescents: Pharmacogenetic anomalies of cytochrome P450 2D6]. Encephale 2021; 47:227-234. [PMID: 33551122 DOI: 10.1016/j.encep.2020.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/04/2020] [Accepted: 09/28/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Some patients in child and adolescent psychiatry present resistance to psychotropic drugs, often resulting in polytherapy, an increased risk of adverse events, and more frequent and longer hospitalisation. Psychotropic drugs are mainly metabolised in the liver, in particular by the CYP2D6 subunit of cytochrome P450. Anomalies such as a duplication of the CYP2D6 gene related to an ultra-rapid metaboliser phenotype has been described to be linked to clinical efficacy. However, little research has been done in child and adolescent psychiatry. METHODS A multi-centric cross-sectional study in the southeast of France explored the relation between pharmaco-resistance to psychotropic drugs and the prevalence of duplications or polymorphisms of CYP2D6 associated with an ultra-rapid phenotype in children and adolescents with severe mental health disease. RESULTS Twenty-two patients have been included. The presence of an ultra-rapid phenotype concerns one patient in our study. A second patient presents a slow metaboliser phenotype. CONCLUSIONS This study allows a clinical characterisation of the population of pediatric drug-resistant patients whose severity and the impact of their pathology are major and require long-term care associated with repeated hospitalisations, multiple drug prescriptions and numerous side effects. However, a link between drug resistance to psychotropic drugs and CYP2D6 UFM abnormalities could not be confirmed. An additional pharmacogenetic analysis by a panel of genes applied in the metabolism, transport and action of psychotropic drugs should be considered to answer questions about the resistance and independent effects of CYP2D6.
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Affiliation(s)
- A David
- Service universitaire de psychiatrie de l'enfant et de l'adolescent, hôpitaux pédiatriques de Nice CHU-Lenval, 57, avenue de la Californie, 06200 Nice, France
| | - A Fernandez
- Service universitaire de psychiatrie de l'enfant et de l'adolescent, hôpitaux pédiatriques de Nice CHU-Lenval, 57, avenue de la Californie, 06200 Nice, France; Université Côte d'Azur, CoBTek, FRIS, Nice, France
| | - M-L Menard
- Service universitaire de psychiatrie de l'enfant et de l'adolescent, hôpitaux pédiatriques de Nice CHU-Lenval, 57, avenue de la Californie, 06200 Nice, France; Université Côte d'Azur, CoBTek, FRIS, Nice, France
| | - E Dor
- Service universitaire de psychiatrie de l'enfant et de l'adolescent, hôpitaux pédiatriques de Nice CHU-Lenval, 57, avenue de la Californie, 06200 Nice, France; Université Côte d'Azur, CoBTek, FRIS, Nice, France
| | - G Leali
- Service de psychiatrie de l'enfant, hôpitaux pédiatriques de Nice, CHU-Lenval, 06200 Nice, France
| | - F Maria
- Service universitaire de psychiatrie de l'enfant et de l'adolescent, hôpitaux pédiatriques de Nice CHU-Lenval, 57, avenue de la Californie, 06200 Nice, France
| | - C Cruzel
- Délégation à la recherche clinique et à l'innovation, CHU de Nice, 06000 Nice, France
| | - F Askenazy
- Service universitaire de psychiatrie de l'enfant et de l'adolescent, hôpitaux pédiatriques de Nice CHU-Lenval, 57, avenue de la Californie, 06200 Nice, France; Université Côte d'Azur, CoBTek, FRIS, Nice, France
| | - C Verstuyft
- Service de génétique moléculaire, pharmacogénétique et hormonologie, centre de ressource biologie Paris-Sud, hôpital Bicêtre, groupe hospitalier Paris Sud, AP-HP, Le Kremlin Bicêtre, France; Université Paris-Sud, CESP/UMR-S1178, Équipe "dépression et antidépresseurs", Faculté de médecine, Université Paris-Sud, Inserm, 78, rue Général-Leclerc, 94270 Le Kremlin-Bicêtre, Paris, France
| | - S Thümmler
- Service universitaire de psychiatrie de l'enfant et de l'adolescent, hôpitaux pédiatriques de Nice CHU-Lenval, 57, avenue de la Californie, 06200 Nice, France; Université Côte d'Azur, CoBTek, FRIS, Nice, France.
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Maruf AA, Stein K, Arnold PD, Aitchison KJ, Müller DJ, Bousman C. CYP2D6 and Antipsychotic Treatment Outcomes in Children and Youth: A Systematic Review. J Child Adolesc Psychopharmacol 2021; 31:33-45. [PMID: 33074724 DOI: 10.1089/cap.2020.0093] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objective: To systematically review the impact of CYP2D6 genetic variation on antipsychotic pharmacokinetics, efficacy, and adverse drug reactions among children and youth. Method: The published literature was systematically searched in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations and critically evaluated using standardized tools and consensus criteria. Results: A total of 20 eligible studies comprising 1078 children and youth were evaluated. The included studies were of fair to moderate quality and included mostly males, individuals of European ancestry, and those treated with risperidone. CYP2D6 poor metabolizers (PMs) were consistently shown to have increased concentrations of risperidone relative to normal metabolizers (NMs). PMs were also consistently shown to have a greater propensity to experience antipsychotic (primarily risperidone) associated adverse drug reactions relative to NMs. However, robust evidence for an association between CYP2D6 and efficacy was less apparent. Conclusion and Clinical Significance: The current knowledge base suggests that CYP2D6 genetic variation has an appreciable impact on antipsychotic pharmacokinetics and the propensity for adverse drug reactions, particularly among children receiving risperidone treatment. However, several limitations with the current literature (e.g., sample sizes, study design, sample heterogeneity) should be addressed in future studies. Assuming that future studies support the link between CYP2D6 genetic variation and antipsychotic outcomes, we would anticipate an increase in the implementation of CYP2D6-guided antipsychotic drug selection and dose optimization in child and adolescent psychiatric services.
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Affiliation(s)
- Abdullah Al Maruf
- The Mathison Centre for Mental Health Research and Education, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Psychiatry, University of Calgary, Calgary, Canada.,Department of Physiology and Pharmacology, University of Calgary, Calgary, Canada
| | - Kiera Stein
- Department of Medical Genetics, University of Calgary, Calgary, Canada
| | - Paul D Arnold
- The Mathison Centre for Mental Health Research and Education, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Psychiatry, University of Calgary, Calgary, Canada.,Department of Medical Genetics, University of Calgary, Calgary, Canada
| | - Katherine J Aitchison
- Departments of Psychiatry and Medical Genetics, University of Alberta, Edmonton, Canada.,Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Canada
| | - Daniel J Müller
- Pharmacogenetics Research Clinic, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Chad Bousman
- The Mathison Centre for Mental Health Research and Education, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Psychiatry, University of Calgary, Calgary, Canada.,Department of Medical Genetics, University of Calgary, Calgary, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
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Schifano F, Chiappini S, Miuli A, Mosca A, Santovito MC, Corkery JM, Guirguis A, Pettorruso M, Di Giannantonio M, Martinotti G. Focus on Over-the-Counter Drugs' Misuse: A Systematic Review on Antihistamines, Cough Medicines, and Decongestants. Front Psychiatry 2021; 12:657397. [PMID: 34025478 PMCID: PMC8138162 DOI: 10.3389/fpsyt.2021.657397] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 03/15/2021] [Indexed: 12/18/2022] Open
Abstract
Background: Over the past 20 years or so, the drug misuse scenario has seen the emergence of both prescription-only and over-the-counter (OTC) medications being reported as ingested for recreational purposes. OTC drugs such as antihistamines, cough/cold medications, and decongestants are reportedly the most popular in being diverted and misused. Objective: While the current related knowledge is limited, the aim here was to examine the published clinical data on OTC misuse, focusing on antihistamines (e.g., diphenhydramine, promethazine, chlorpheniramine, and dimenhydrinate), dextromethorphan (DXM)- and codeine-based cough medicines, and the nasal decongestant pseudoephedrine. Methods: A systematic literature review was carried out with the help of Scopus, Web of Science databases, and the related gray literature. For data gathering purposes, both the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and PROSPERO guidelines were followed (PROSPERO identification code CRD42020209261). Results: After completion of the selection, eligibility, and screening phases, some 92 articles were here taken into consideration; case reports, surveys, and retrospective case series analyses were included. Findings were organized according to the specific OTC recorded. Most articles focused here on DXM (n = 54) and diphenhydramine (n = 12). When specified, dosages, route(s) of administration, toxicity symptoms (including both physical and psychiatric ones), and outcomes were here reported. Conclusion: Results from the systematic review showed that the OTC misusing issues are both widespread worldwide and popular; vulnerable categories include adolescents and young adults, although real prevalence figures remain unknown, due to a lack of appropriate monitoring systems. Considering the potential, and at times serious, adverse effects associated with OTC misusing issues, healthcare professionals should be vigilant, and ad hoc preventative actions should be designed and implemented.
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Affiliation(s)
- Fabrizio Schifano
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Stefania Chiappini
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom.,Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University, Chieti, Italy
| | - Andrea Miuli
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University, Chieti, Italy
| | - Alessio Mosca
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University, Chieti, Italy
| | - Maria Chiara Santovito
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University, Chieti, Italy
| | - John M Corkery
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Amira Guirguis
- Swansea University Medical School, Institute of Life Sciences 2, Swansea University, Swansea, United Kingdom
| | - Mauro Pettorruso
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University, Chieti, Italy
| | - Massimo Di Giannantonio
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University, Chieti, Italy
| | - Giovanni Martinotti
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University, Chieti, Italy
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10
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Lao KSJ, Zhao J, Blais JE, Lam L, Wong ICK, Besag FMC, Chang WC, Castle DJ, Chan EW. Antipsychotics and Risk of Neuroleptic Malignant Syndrome: A Population-Based Cohort and Case-Crossover Study. CNS Drugs 2020; 34:1165-1175. [PMID: 33010024 DOI: 10.1007/s40263-020-00767-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/15/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Neuroleptic malignant syndrome (NMS) is a rare and acute adverse drug reaction associated with antipsychotic therapy. However, few data on the risk and epidemiology of NMS are available. OBJECTIVES The aim of this study was to ascertain the incidence risk and all-cause mortality of NMS associated with antipsychotic use, and to assess the association of recent antipsychotic exposure and NMS. METHODS We did a population-based study using data from the Hong Kong Hospital Authority's Clinical Data Analysis and Reporting System database. Cases had a first diagnosis of NMS between 1 January 2004 and 30 November 2017. A case-crossover analysis was used to compare antipsychotic exposure 30 days before the diagnosis of NMS (index date) and a reference period 91-120 days before the index date. To adjust for potential time trends in antipsychotic exposure, we sampled from cases to match current cases and future cases, and further adjusted for select medications and acute medical conditions. RESULTS 297,647 patients were prescribed antipsychotics, and the incidence risk of NMS was 0.11%. Of the 336 cases included in the case-crossover analysis, 20 (6%) died within 30 days after the index date; only one case had NMS recorded as the primary cause of death. When compared with the reference period, cases were more frequently prescribed multiple antipsychotics (15.8% vs 26.8%; standardized mean difference [SMD] 0.27) and short-acting injectable antipsychotics (3.6% vs 13.7%; SMD 0.37) during the 30 days prior to the diagnosis of NMS. Odds ratios for antipsychotic exposure in the case-crossover, case-crossover adjusted for time trend, and case-crossover adjusted for time trend and potential confounders analysis were 8.00 (95% confidence interval 3.42-18.69), 5.88 (2.46-14.04), and 4.77 (1.95-11.66). CONCLUSIONS Our results suggest that recent use of antipsychotics is associated with NMS. Although a case-only design inherently controls for confounding by time-invariant factors, residual confounding by acute medical conditions with similar presentations to NMS cannot be fully excluded.
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Affiliation(s)
- Kim S J Lao
- Department of Pharmacology and Pharmacy, Centre for Safe Medication Practice and Research, The University of Hong Kong, Office 02-08, 2/F Laboratory Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China.,Global Medical Affairs, Merck Research Laboratories, Shanghai, China
| | - Jiaxi Zhao
- Department of Pharmacology and Pharmacy, Centre for Safe Medication Practice and Research, The University of Hong Kong, Office 02-08, 2/F Laboratory Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
| | - Joseph Edgar Blais
- Department of Pharmacology and Pharmacy, Centre for Safe Medication Practice and Research, The University of Hong Kong, Office 02-08, 2/F Laboratory Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
| | - Lam Lam
- Department of Pharmacology and Pharmacy, Centre for Safe Medication Practice and Research, The University of Hong Kong, Office 02-08, 2/F Laboratory Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
| | - Ian C K Wong
- Department of Pharmacology and Pharmacy, Centre for Safe Medication Practice and Research, The University of Hong Kong, Office 02-08, 2/F Laboratory Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China.,Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
| | - Frank M C Besag
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK.,East London NHS Foundation Trust, Bedford, Bedfordshire, UK.,Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Wing Chung Chang
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.,State Key Laboratory of Brain & Cognitive Sciences, The University of Hong Kong, Hong Kong SAR, China
| | - David J Castle
- St Vincent's Hospital, Melbourne, Vic, Australia.,Department of Psychiatry, University of Melbourne, Melbourne, Vic, Australia
| | - Esther W Chan
- Department of Pharmacology and Pharmacy, Centre for Safe Medication Practice and Research, The University of Hong Kong, Office 02-08, 2/F Laboratory Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China. .,Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
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11
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León-Amenero D, Huarcaya-Victoria J. Neuroleptic Malignant Syndrome in Children and Adolescents: Systematic Review of Case Reports. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2020; 50:S0034-7450(19)30075-7. [PMID: 33735054 DOI: 10.1016/j.rcp.2019.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 10/28/2019] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Neuroleptic malignant syndrome (NMS) is a rare and potentially fatal drug adverse reaction. There are still few studies of this entity in the child-adolescent population. OBJECTIVES Describe the clinical, laboratory and therapeutic characteristics of children and adolescent patients with NMS. Analyse the grouping of symptoms present in NMS in the same population. MATERIAL AND METHODS A MEDLINE/PubMed search of all reported cases of NMS from January 2000 to November 2018 was performed and demographic, clinical, laboratory and therapeutic variables were identified. A factorial analysis of the symptoms was performed. RESULTS 57 patients (42 males and 15 females) were included, (mean age 13.65±3.89 years). The onset of NMS occurred at 11.25±20.27 days with typical antipsychotics and at 13.69±22.43 days with atypical antipsychotics. The most common symptoms were muscle stiffness (84.2%), autonomic instability (84.2%) and fever (78.9). The most common laboratory findings were CPK elevation and leucocytosis (42.1%). The most used treatment was benzodiazepines (28.1%). In the exploratory factorial analysis of the symptoms we found 3factors: 1) "Catatonic" with mutism (0.912), negativism (0.825) and waxy flexibility (0.522); 2) "Extrapyramidal" with altered gait (0.860), involuntary abnormal movements (0.605), muscle stiffness (0.534) and sialorrhoea (0.430); and 3) "Autonomic instability" with fever (0.798), impaired consciousness (0.795) and autonomic instability (0.387). CONCLUSIONS NMS in children and adolescents could be of 3types: catatonic, extrapyramidal and autonomic unstable.
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Affiliation(s)
- Deborah León-Amenero
- Médico psiquiatría de niños y adolescentes, Servicio de Psiquiatría Infanto-juvenil, Departamento de Psiquiatría, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Perú
| | - Jeff Huarcaya-Victoria
- Universidad de San Martín de Porres, Facultad de Medicina, Centro de Investigación en Salud Pública, Lima, Perú; Médico psiquiatra, Servicio de Psiquiatría General, Departamento de Psiquiatría, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Perú.
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12
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David A, Fernandez A, Menard ML, Dor E, Dugand N, Verstuyft C, Askenazy F, Thümmler S. Pédopsychiatrie et pharmacogénétique : pharmacorésistance aux psychotropes et duplication du cytochrome P450 2D6, à propos de trois cas cliniques. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.neurenf.2019.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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13
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Pharmacorésistance aux psychotropes et anomalies pharmacogénétiques du cytochrome P450 2D6 : vers une médecine personnalisée en pédopsychiatrie, présentation d’un protocole de recherche. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.neurenf.2018.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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14
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Thümmler S, Dor E, David R, Leali G, Battista M, David A, Askenazy F, Verstuyft C. Pharmacoresistant Severe Mental Health Disorders in Children and Adolescents: Functional Abnormalities of Cytochrome P450 2D6. Front Psychiatry 2018; 9:2. [PMID: 29472872 PMCID: PMC5810290 DOI: 10.3389/fpsyt.2018.00002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 01/08/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Severe mental health disorders in children and adolescents represent a major public health problem. Despite adequate drug treatment, some patients develop pharmacoresistant disease. As a consequence, physicians are confronted with prescribing challenges, prolonged hospitalization and increased risk of adverse events, thus aggravating short-, medium-, and long-term prognosis. The majority of psychotropic treatments, particularly antipsychotics and antidepressants, are metabolized at hepatic level by cytochrome P450 (CYP), particularly by CYP3A4 and CYP2D6. Several CYP2D6 genetic polymorphisms are described to be associated with ultrarapid (UM) or poor drug metabolism (PM), inducing clinical resistance and/or adverse events, and might therefore be related to pharmacoresistant severe mental health disease. CASE PRESENTATION A total of nine pharmacoresistant patients (four females, five males) aged 11-16 (mean 14.1) years have been genotyped for CYP2D6 between January, 2015 and April, 2016. Patients were diagnosed with schizophrenia (n = 5), autism spectrum disorders (n = 2), intellectual disability with challenging behavior (n = 2), oppositional defiant disorder (n = 1), and post-traumatic stress and borderline personality disorders (n = 1). They had a treatment history with on average 6.1 (3-9) psychotropic, 5 (3-7) antipsychotic, and 3.4 (2-5) CYP2D6-metabolized antipsychotic and antidepressant molecules. Five patients (56%) presented functional anomalies of the CYP2D6 gene: three patients were UM metabolizers with gene duplication and two patients were PM with *4/*41 and *3/*4 polymorphisms. CONCLUSION Functional anomalies of CYP2D6 concerned more than half of our pediatric inpatient sample with pharmacoresistant disease. However, our case reports are limited by the low sample size. Nevertheless, knowledge of individual metabolism and in particular CYP2D6 genotyping should be considered for clinical workup and therapy adjustment in resistant patients in child and adolescent psychiatry and might permit better treatment outcome, increased treatment adherence and diminished adverse events.
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Affiliation(s)
- Susanne Thümmler
- University Department of Child and Adolescent Psychiatry, Children's Hospitals of Nice CHU-Lenval, Nice, France.,CoBTek, Université Côte d'Azur, Nice, France
| | - Emmanuelle Dor
- University Department of Child and Adolescent Psychiatry, Children's Hospitals of Nice CHU-Lenval, Nice, France.,CoBTek, Université Côte d'Azur, Nice, France
| | | | - Graziella Leali
- Department of Child Psychiatry, Nice Children's Hospitals CHU-Lenval, Nice, France
| | - Michele Battista
- University Department of Child and Adolescent Psychiatry, Children's Hospitals of Nice CHU-Lenval, Nice, France.,Department of Child and Adolescent Psychiatry, Hospital of Fréjus, Fréjus, France
| | - Alexia David
- University Department of Child and Adolescent Psychiatry, Children's Hospitals of Nice CHU-Lenval, Nice, France
| | - Florence Askenazy
- University Department of Child and Adolescent Psychiatry, Children's Hospitals of Nice CHU-Lenval, Nice, France.,CoBTek, Université Côte d'Azur, Nice, France
| | - Céline Verstuyft
- Service de génétique moléculaire, pharmacogénétique et hormonologie, Centre de Ressource Biologie Paris-Sud, Hôpital Bicêtre, Groupe Hospitalier Paris Sud, AP-HP, Le Kremlin Bicêtre, Nice, France.,Université Paris-Sud, UMR 1184, Faculté de médecine, Paris, France
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15
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Sychev DA, Zastrozhin MS, Miroshnichenko II, Baymeeva NV, Smirnov VV, Grishina EA, Ryzhikova KA, Mirzaev KB, Markov DD, Skryabin VY, Snalina NE, Nosikova PG, Savchenko LM, Bryun EA. Genotyping and phenotyping of CYP2D6 and CYP3A isoenzymes in patients with alcohol use disorder: correlation with haloperidol plasma concentration. Drug Metab Pers Ther 2017; 32:129-136. [PMID: 28787271 DOI: 10.1515/dmpt-2017-0021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 07/13/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Haloperidol is used for the treatment of alcohol use disorders in patients with signs of alcohol-related psychosis. Haloperidol therapy poses a high risk of adverse drug reactions (ADR). Contradictory data, which include the effects of genetic polymorphisms in genes encoding the elements of haloperidol biotransformation system on haloperidol metabolism rate and plasma drug concentration ratio, are described in patients with different genotypes. The primary objective of this study was to investigate the effects of CYP2D6 and CYP3A5 genetic polymorphisms on haloperidol equilibrium concentration in patients with alcohol use disorder. METHODS The study included 69 male patients with alcohol use disorder. Genotyping was performed using the allele-specific real-time PCR. CYP2D6 and CYP3A were phenotyped with HPLC-MS using the concentration of endogenous substrate of the enzyme and its urinary metabolites [6-hydroxy-1,2,3,4-tetrahydro-β-carboline(6-HO-THBC) to pinoline ratio for CYP2D6 and 6-β-hydroxycortisol to cortisol ratio for CYP3A]. The equilibrium plasma concentration was determined using LC-MS-MS. RESULTS Results indicated that both C/D indexes and equilibrium concentration levels depend on CYP2D6 genetic polymorphism, but only in patients receiving haloperidol intramuscular injections [0.26 (0.09; 0.48) vs. 0.54 (0.44; 0.74), p=0.037]. CONCLUSIONS The study demonstrates that CYP2D6 genetic polymorphism (1846G>A) can affect haloperidol concentration levels in patients with alcohol use disorder.
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16
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Demkow U, Wolańczyk T. Genetic tests in major psychiatric disorders-integrating molecular medicine with clinical psychiatry-why is it so difficult? Transl Psychiatry 2017; 7:e1151. [PMID: 28608853 PMCID: PMC5537634 DOI: 10.1038/tp.2017.106] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 03/29/2017] [Indexed: 02/06/2023] Open
Abstract
With the advent of post-genomic era, new technologies create extraordinary possibilities for diagnostics and personalized therapy, transforming todays' medicine. Rooted in both medical genetics and clinical psychiatry, the paper is designed as an integrated source of information of the current and potential future application of emerging genomic technologies as diagnostic tools in psychiatry, moving beyond the classical concept of patient approach. Selected approaches are presented, starting from currently used technologies (next-generation sequencing (NGS) and microarrays), followed by newer options (reverse phenotyping). Next, we describe an old concept in a new light (endophenotypes), subsequently coming up with a sophisticated and complex approach (gene networks) ending by a nascent field (computational psychiatry). The challenges and barriers that exist to translate genomic research to real-world patient assessment are further discussed. We emphasize the view that only a paradigm shift can bring a fundamental change in psychiatric practice, allowing to disentangle the intricacies of mental diseases. All the diagnostic methods, as described, are directed at uncovering the integrity of the system including many types of relations within a complex structure. The integrative system approach offers new opportunity to connect genetic background with specific diseases entities, or concurrently, with symptoms regardless of a diagnosis. To advance the field, we propose concerted cross-disciplinary effort to provide a diagnostic platform operating at the general level of genetic pathogenesis of complex-trait psychiatric disorders rather than at the individual level of a specific disease.
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Affiliation(s)
- U Demkow
- Department of Laboratory Diagnostics and Clinical Immunology of Developmental Age, Medical University of Warsaw, Warsaw, Poland,Department of Laboratory Diagnostics and Clinical Immunology of Developmental Age, Medical University of Warsaw, Zwirki i Wigury 63a, Warsaw 02-091, Poland. E-mail:
| | - T Wolańczyk
- Department of Child Psychiatry, Medical University of Warsaw, Warsaw, Poland
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17
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Oruch R, Pryme IF, Engelsen BA, Lund A. Neuroleptic malignant syndrome: an easily overlooked neurologic emergency. Neuropsychiatr Dis Treat 2017; 13:161-175. [PMID: 28144147 PMCID: PMC5248946 DOI: 10.2147/ndt.s118438] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Neuroleptic malignant syndrome is an unpredictable iatrogenic neurologic emergency condition, mainly arising as an idiosyncratic reaction to antipsychotic agent use. It is characterized by distinctive clinical features including a change in mental status, generalized rigidity, hyperpyrexia, and dysautonomia. It can be lethal if not diagnosed and treated properly. Mortality and morbidity attributed to this syndrome have recently declined markedly due to greater awareness, earlier diagnosis, and intensive care intervention. In most cases, the syndrome occurs as a result of a rapid increase in a dose of neuroleptic, especially one of the long-acting ones. Pathophysiology behind this syndrome is attributed to a dopamine receptor blockade inside the neurons rendered by the offending drug and excessive calcium release from the sarcoplasmic reticulum of skeletal myocytes. Laboratory tests, although not diagnostic, may assist in assessing the severity of the syndrome and also the consequent complications. The syndrome has been described in all age groups and occurs more in males than in females. Genetics appears to be central regarding the etiology of the syndrome. Stopping the use of the offending agent, cold intravenous fluids, and removal of the causative agent and its possible active metabolites is the cornerstone of treatment. Periodic observation of psychotic patients recently started on antipsychotic medications, especially those being treated with depot preparations, may aid to an early diagnosis of the syndrome and lead to early treatment.
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Affiliation(s)
- Ramadhan Oruch
- Department of Pharmacology and Toxicology, School of Pharmacy, Benghazi University, Benghazi, Libya
| | | | | | - Anders Lund
- Department of Clinical Medicine, Section of Psychiatry, University of Bergen, Bergen, Norway
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18
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Sychev DA, Zastrozhin MS, Smirnov VV, Grishina EA, Savchenko LM, Bryun EA. The correlation between CYP2D6 isoenzyme activity and haloperidol efficacy and safety profile in patients with alcohol addiction during the exacerbation of the addiction. PHARMACOGENOMICS & PERSONALIZED MEDICINE 2016; 9:89-95. [PMID: 27695358 PMCID: PMC5028170 DOI: 10.2147/pgpm.s110385] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Today, it is proved that isoenzymes CYP2D6 and CYP3A4 are involved in metabolism of haloperidol. In our previous investigation, we found a medium correlation between the efficacy and safety of haloperidol and the activity of CYP3A4 in patients with alcohol abuse. Objective The aim of this study was to evaluate the correlation between the activity of CYP2D6 and the efficacy and safety of haloperidol in patients with diagnosed alcohol abuse. Methods The study involved 70 men (average age: 40.83±9.92 years) with alcohol addiction. A series of psychometric scales were used in the research. The activity of CYP2D6 was evaluated by high-performance liquid chromatography with mass spectrometry using the ratio of 6-hydroxy-1,2,3,4-tetrahydro-beta-carboline to pinoline. Genotyping of CYP2D6 (1846G>A) was performed using real-time polymerase chain reaction. Results According to results of correlation analysis, statistically significant values of Spearman correlation coefficient (rs) between the activity of CYP2D6 and the difference of points in psychometric scale were obtained in patients receiving haloperidol in injection form (Sheehan Clinical Anxiety Rating Scale =−0.721 [P<0.001] and Udvald for Kliniske Undersogelser Side Effect Rating Scale =0.692 [P<0.001]) and in those receiving haloperidol in tablet form (Covi Anxiety Scale =−0.851 [P<0.001] and Udvald for Kliniske Undersogelser Side Effect Rating Scale =0.797 [P<0.001]). Conclusion This study demonstrated the correlations between the activity of CYP2D6 isozyme and the efficacy and safety of haloperidol in patients with alcohol addiction.
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Affiliation(s)
| | - Mikhail Sergeevich Zastrozhin
- Russian Medical Academy of Postgraduate Education, Ministry of Health of the Russian Federation; Department of Public Health, Moscow Research and Practical Centre for Narcology; Peoples' Friendship University of Russia
| | - Valery Valerieevich Smirnov
- National Research Center, Institute of Immunology Federal Medical-Biological Agency of Russia, Moscow, Russia
| | | | | | - Evgeny Alekseevich Bryun
- Russian Medical Academy of Postgraduate Education, Ministry of Health of the Russian Federation; Department of Public Health, Moscow Research and Practical Centre for Narcology
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19
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Šimić I, Potočnjak I, Kraljičković I, Stanić Benić M, Čegec I, Juričić Nahal D, Ganoci L, Božina N. CYP2D6 *6/*6 genotype and drug interactions as cause of haloperidol-induced extrapyramidal symptoms. Pharmacogenomics 2016; 17:1385-9. [PMID: 27469576 DOI: 10.2217/pgs-2016-0069] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
A 66-year-old male Caucasian, received 1 mg of haloperidol orally and rapidly developed severe iatrogenic extrapyramidal symptoms. Treatment was immediately discontinued, and the side effects resolved. Haloperidol is mainly metabolized by Phase I CYP2D6 and to the lesser extent by CYP3A4 and by Phase II UGT2B7 enzymes. Genotyping was performed revealing CYP2D6*6/*6, CYP3A4*1/*1, and UGT2B7 -161 C/T genotypes, implicating poor, extensive and intermediate metabolism, respectively. Of the CYPs, haloperidol is metabolized by CYP2D6 and CYP3A4 primarily. It was the introduction of ciprofloxacin which was a trigger for the development of adverse drug reaction due to inhibition of CYP3A4, which was in presented patient main metabolic pathway for haloperidol since he was CYP2D6 poor metabolizer. Presented case report highlights the importance of genotyping. Pharmacogenetics testing should be considered when drug toxicity is suspected, polymorphic metabolic pathways used and drugs concomitantly applied.
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Affiliation(s)
- Iveta Šimić
- University of Zagreb School of Medicine, Zagreb, Croatia.,Division of Clinical Pharmacology, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Ines Potočnjak
- Clinical Unit of Clinical Pharmacology & Toxicology, Department of Medicine, University Hospital Centre Sisters of Charity, Zagreb, Croatia
| | - Iva Kraljičković
- Division of Clinical Pharmacology, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Mirjana Stanić Benić
- Unit for Clinical Pharmacology, University Hospital Centre Rijeka, Rijeka, Croatia
| | - Ivana Čegec
- Division of Clinical Pharmacology, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Danica Juričić Nahal
- Division of Clinical Pharmacology, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Lana Ganoci
- University of Zagreb School of Medicine, Zagreb, Croatia.,Department of Laboratory Diagnostics, University Hospital Centre Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Nada Božina
- University of Zagreb School of Medicine, Zagreb, Croatia.,Department of Laboratory Diagnostics, University Hospital Centre Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
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20
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Zastrozhin M, Smirnov V, Sychev D, Savchenko L, Bryun E, Matis O. CYP3A4 activity and haloperidol effects in alcohol addicts. INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE 2015; 27 Suppl 1:S23-4. [DOI: 10.3233/jrs-150676] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- M.S. Zastrozhin
- Russian Medical Academy of Postgraduate Education, Moscow, Russia
- Moscow Research and Practical Centre for Narcology of the Departament of Public Health, Moscow, Russia
| | - V.V. Smirnov
- National Research Center – Institute of Immunology, Federal Medical-Biological Agency of Russia, Moscow, Russia
| | - D.A. Sychev
- Russian Medical Academy of Postgraduate Education, Moscow, Russia
| | - L.M. Savchenko
- Russian Medical Academy of Postgraduate Education, Moscow, Russia
| | - E.A. Bryun
- Moscow Research and Practical Centre for Narcology of the Departament of Public Health, Moscow, Russia
| | - O.A. Matis
- Moscow Research and Practical Centre for Narcology of the Departament of Public Health, Moscow, Russia
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