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Acuff KN, Villatoro GA, Baxter SL. Acute Bilateral Periorbital Edema in a Psychiatric Patient. JAMA Ophthalmol 2024:2821944. [PMID: 39088236 DOI: 10.1001/jamaophthalmol.2024.2815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
An older patient with history of alcohol use disorder was admitted for altered mental status and received valproic acid and olanzapine from the psychiatric service. On hospital day 2, the patient acutely developed bilateral periorbital edema. What would you do next?
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Affiliation(s)
- Kaela N Acuff
- Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California, San Diego, La Jolla
| | - George A Villatoro
- Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California, San Diego, La Jolla
| | - Sally L Baxter
- Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California, San Diego, La Jolla
- Division of Biomedical Informatics, Department of Medicine, University of California, San Diego, La Jolla
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2
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Zhang H, Cao F, Zhang S, Wang Z, Li C. Successful Treatment of a Patient with brain tissue edema associated with Olanzapine overdose. Heliyon 2024; 10:e30201. [PMID: 38778957 PMCID: PMC11108836 DOI: 10.1016/j.heliyon.2024.e30201] [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: 09/22/2023] [Revised: 04/18/2024] [Accepted: 04/22/2024] [Indexed: 05/25/2024] Open
Abstract
Olanzapine is one of the atypical antipsychotic agents which is being increasingly used, and it is synthetic derivative of thienobenzodiazepine with antipsychotic, and antinausea, and antiemetic activities. Olanzapine overdose is mainly associated with the development of anticholinergic toxicity and is characterized by central nervous system (CNS) suppression, tachycardia, and delirium. As little is yet known about the effects of this agent in toxic doses, it is important to report the features of overdose. Herein, we reported a 28-year-old male with a history of mental illness and substance abuse, who was admitted in a comatose state with generalized tonic-clonic seizures. Head computed tomography (CT) and cerebrospinal fluid (CSF) analysis revealed significant cerebral edema and raised intracranial pressure, indicative of olanzapine-induced neurotoxicity. Management involved immediate cessation of olanzapine, administration of intravenous mannitol for cerebral edema, and supportive care. The patient's condition gradually improved with these interventions. Elevated olanzapine plasma concentration confirmed the diagnosis of overdose. Cranial pressure-lowering treatment has a certain effect on improving the condition of patients.
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Affiliation(s)
- Houwen Zhang
- The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China
- Department of Neurology, The second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Fangzheng Cao
- The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China
- Department of Neurology, The second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Sheng Zhang
- Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Zhongxiu Wang
- Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Chunrong Li
- Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
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3
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Engel J, Haack B, Zolk O, Greiner T, Heinze M, Toto S, Seifert J, Bleich S, Glocker C, Grohmann R, Schneider M, Stübner S. Edema related to treatment with psychotropic drugs. J Neural Transm (Vienna) 2024; 131:253-266. [PMID: 38353811 PMCID: PMC10874320 DOI: 10.1007/s00702-024-02738-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 01/02/2024] [Indexed: 02/18/2024]
Abstract
Edema as an adverse drug reaction is a commonly underestimated yet potentially debilitating condition. This study analyzes the incidence of severe psychotropic drug-induced edema (e.g., edema affecting the face, legs, or multiple body parts and lasting for more than 1 week, or in any case necessitating subsequent diuretic use) among psychiatric inpatients. The cases under examination are derived from an observational pharmacovigilance program conducted in German-speaking countries ("Arzneimittelsicherheit in der Psychiatrie", AMSP) from 1993 to 2016. Among the 462,661 inpatients monitored, severe edema was reported in 231 cases, resulting in an incidence of 0.05%. Edema occurred more frequently in women (80% of all cases) and older patients (mean age 51.8 years). Pregabalin had the highest incidence of severe edema, affecting 1.46‰ of patients treated with pregabalin, followed by mirtazapine (0.8‰). The majority of edema cases showed a positive response to appropriate countermeasures, such as dose reduction and drug discontinuation, and resolved by the end of the observation period. While most instances of drug-induced edema are reversible, they can have a significant impact on patient well-being and potentially result in decreased treatment adherence. It is, therefore, crucial to remain vigilant regarding risk-increasing circumstances during treatment with psychotropic drugs.
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Affiliation(s)
- Johanna Engel
- Brandenburg Medical School, University Clinic for Psychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Seebad 82/83, 15562, Rüdersdorf bei Berlin, Germany.
| | - Beatrice Haack
- Brandenburg Medical School, University Clinic for Psychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Seebad 82/83, 15562, Rüdersdorf bei Berlin, Germany
| | - Oliver Zolk
- Institute of Clinical Pharmacology of the Brandenburg Medical School, Immanuel Klinik Rüdersdorf, Seebad 82/83, 15562, Rüdersdorf bei Berlin, Germany
| | - Timo Greiner
- Brandenburg Medical School, University Clinic for Psychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Seebad 82/83, 15562, Rüdersdorf bei Berlin, Germany
| | - Martin Heinze
- Brandenburg Medical School, University Clinic for Psychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Seebad 82/83, 15562, Rüdersdorf bei Berlin, Germany
| | - Sermin Toto
- Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Johanna Seifert
- Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Stefan Bleich
- Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Catherine Glocker
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, Nussbaumstr. 7, 80336, Munich, Germany
| | - Renate Grohmann
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, Nussbaumstr. 7, 80336, Munich, Germany
| | - Michael Schneider
- Brandenburg Medical School, University Clinic for Psychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Seebad 82/83, 15562, Rüdersdorf bei Berlin, Germany
| | - Susanne Stübner
- Maßregelvollzugsleitung, Klinik für Forensische Psychiatrie, Bezirksklinikum Ansbach, Ludwig-Maximilians-Universität München, Feuchtwanger Straße 38, 91522, Ansbach, Germany
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4
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Sinnathamby ES, Urban BT, Clark RA, Roberts LT, De Witt AJ, Wenger DM, Mouhaffel A, Willett O, Ahmadzadeh S, Shekoohi S, Kaye AD, Varrassi G. Etiology of Drug-Induced Edema: A Review of Dihydropyridine, Thiazolidinedione, and Other Medications Causing Edema. Cureus 2024; 16:e53400. [PMID: 38435190 PMCID: PMC10908346 DOI: 10.7759/cureus.53400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 01/31/2024] [Indexed: 03/05/2024] Open
Abstract
Edema is an accumulation of fluid in the body's tissues that affects millions of Americans yearly. It can affect multiple body parts, for example, the brain or eyes, but often occurs in the periphery, including the feet and legs. Medications, such as dihydropyridine and thiazolidinediones (TZDs), can be the etiology of edema. Edema can develop in association with problems in the vasculature or lymphatic flow. In recent years, a better understanding of these drug-induced mechanisms has been appreciated. Specifically, dihydropyridines can increase hydrostatic pressure and cause selective pre-capillary vessel vasodilation. TZDs can cause edema through increased vascular permeability and increased hydrostatic pressure. Specifically, peroxisome proliferator-activated receptor gamma (PPARγ) stimulation increases vascular endothelial permeability, vascular endothelial growth factor (VEGF) secretion, renal sodium, and fluid retention. Other drugs that can cause edema include neuropathic pain agents, dopamine agonists, antipsychotics, nitrates, nonsteroidal anti-inflammatory (NSAIDS), steroids, angiotensin-converting enzyme (ACE) inhibitors, and insulin. There are various clinical presentations of edema. Since multiple mechanisms can induce edema, it is important to understand the basic mechanisms and pathophysiology of drug-induced edema. Edema can even become fatal. For example, angioedema can occur from ACE inhibitor therapy. In this regard, it is considered a medical emergency when there is laryngeal involvement. This review aims to thoroughly appreciate the multiple causes of drug-induced edema and the ways it can be treated or prevented.
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Affiliation(s)
- Evan S Sinnathamby
- School of Medicine, Louisiana State University Health Sciences Center (LSUHSC) New Orleans, New Orleans, USA
| | - Bretton T Urban
- School of Medicine, Louisiana State University Health Sciences Center (LSUHSC) New Orleans, New Orleans, USA
| | - Robert A Clark
- School of Medicine, Louisiana State University Health Sciences Center (LSUHSC) New Orleans, New Orleans, USA
| | - Logan T Roberts
- School of Medicine, Louisiana State University Health Sciences Center (LSUHSC) New Orleans, New Orleans, USA
| | - Audrey J De Witt
- School of Medicine, Louisiana State University (LSU) Health, Shreveport, USA
| | - Danielle M Wenger
- School of Medicine, The University of Arizona College of Medicine - Phoenix, Phoenix, USA
| | - Aya Mouhaffel
- Department of Anesthesiology, Louisiana State University (LSU) Health, Shreveport, USA
| | - Olga Willett
- Department of Anesthesiology, Louisiana State University (LSU) Health, Shreveport, USA
| | - Shahab Ahmadzadeh
- Department of Anesthesiology, Louisiana State University (LSU) Health, Shreveport, USA
| | - Sahar Shekoohi
- Department of Anesthesiology, Louisiana State University (LSU) Health, Shreveport, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University (LSU) Health, Shreveport, USA
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Herlihy M, Duff E, Sadlier M. Olanzapine-induced progressive facial oedema mimicking Morbihan disease. Clin Exp Dermatol 2024; 49:197-199. [PMID: 37935056 DOI: 10.1093/ced/llad367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 11/02/2023] [Indexed: 11/09/2023]
Abstract
We present the case of a 55-year-old man with a 20-year history of olanzapine-induced progressive solid facial oedema mimicking Morbihan disease. Olanzapine was not initially considered as the cause of his facial oedema as he had been on treatment for years prior to disease onset. This case reminds us to do a thorough drug review to rule out an iatrogenic cause before making a diagnosis of Morbihan disease.
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Affiliation(s)
- Maeve Herlihy
- Dermatology Department, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Eimaer Duff
- Dermatology Department, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Muriel Sadlier
- Dermatology Department, University Hospital Limerick, Dooradoyle, Limerick, Ireland
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Elyasi F, Heydari F, Haddadi K. Quetiapine-induced chest wall edema with the swellings of face and extremities in a young hospitalized patient: A case report. Clin Case Rep 2023; 11:e7661. [PMID: 37476600 PMCID: PMC10354354 DOI: 10.1002/ccr3.7661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/05/2023] [Accepted: 06/19/2023] [Indexed: 07/22/2023] Open
Abstract
Key Clinical Message Quetiapine can lead to the face, extremity and particularly chest wall edema in hospitalized patients in the supine position. Abstract Quetiapine (QTP) is known as an atypical antipsychotic agent with some adverse effects, such as edema. However, along this line, peripheral edema is not a life-threatening episode, but it is an important side effect affecting medical compliance. Therefore, QTP-induced chest wall edema with the swellings of the face and the extremities is very rare. This report is about a young man who was admitted in the intensive care unit with multiple trauma (MT). On account of his delirious state, QTP was started at 25 mg and then increased to 75 mg, three times a day. The patient developed swelling of the face, the upper and lower limbs, and the chest wall. After stopping the QTP use, his edema went down. Although there is still speculation about the possible mechanisms of antipsychotic-induced edema, some studies have pointed to the relationship between dopaminergic antagonism and peripheral edema. Therefore, it is very important to pay close attention to this side effect.
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Affiliation(s)
- Forouzan Elyasi
- Sexual and Reproductive Health Research Center, Psychiatry and Behavioral Sciences Research Center, Addiction InstituteMazandaran University of Medical SciencesSariIran
- Department of Psychiatry, Faculty of MedicineMazandaran University of Medical SciencesSariIran
| | - Fatemeh Heydari
- Department of Anesthesiology, Faculty of MedicineMazandaran University of Medical SciencesSariIran
| | - Kaveh Haddadi
- Orthopedic Research CenterMazandaran University of Medical SciencesSariIran
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Clozapine Associated Periorbital Edema in First Episode Psychosis: A Case Report of a Rare Adverse Effect in Treatment-Resistant Schizophrenia. J Clin Psychopharmacol 2022; 42:594-596. [PMID: 36066404 DOI: 10.1097/jcp.0000000000001600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Camilleri D, Fiorini A. Lessons of the month 2: Olanzapine-induced hypothermia and hand oedema. Clin Med (Lond) 2022; 22:285-286. [PMID: 38589093 DOI: 10.7861/clinmed.2022-0113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION We describe a case of olanzapine-induced hypothermia and hand oedema in an older adult with behavioural and psychological symptoms of dementia (BPSD). CASE PRESENTATION An 82-year-old woman with hypothyroidism and dementia was reviewed by the geriatric team at a nursing home in view of lethargy and an unrecordable oral temperature. She was noted to have a bilateral hand oedema and right basal crackles. Investigations revealed high white cell count and inflammatory markers. She was treated as per hypothermia and communityacquired pneumonia protocols. The patient did not have the expected response to treatment. Olanzapine was tailed down and stopped with good effect as it was suspected to be a contributory cause to both the hypothermia and oedema. DISCUSSION AND CONCLUSION Potentially inappropriate polypharmacy can be specifically targeted with effective deprescribing. Treatment review should be encouraged on a regular basis, especially in frail older adults with polypharmacy.
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Buzea CA, Dima L, Correll CU, Manu P. Drug-drug interactions involving antipsychotics and antihypertensives. Expert Opin Drug Metab Toxicol 2022; 18:285-298. [PMID: 35658798 DOI: 10.1080/17425255.2022.2086121] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Antipsychotics represent the mainstay in the treatment of patients diagnosed with major psychiatric disorders. Hypertension, among other components of metabolic syndrome, is a common finding in these patients. For their psychiatric and physical morbidity, many patients receive polypharmacy, exposing them to the risk of clinically relevant drug-drug interactions. AREAS COVERED This review summarizes the knowledge regarding the known or potential drug-drug interactions between antipsychotics and the main drug classes used in the treatment of hypertension. We aimed to provide the clinician an insight into the pharmacokinetic and pharmacodynamic interactions between these drugs for a better choice of combinations of drugs to treat both the mental illness and cardiovascular risk factors. For this, we performed a literature search in PubMed and Scopus databases, up to 31 July 2021. EXPERT OPINION The main pharmacokinetic interactions between antipsychotics and antihypertensive drugs involve mainly the cytochrome P450 system. The pharmacodynamic interactions are produced by multiple mechanisms, leading to concurrent binding to the same receptors. The data available regarding drug-drug interactions is mostly based on case reports and small studies and therefore should be interpreted with caution. The current knowledge is sufficiently strong to guide clinicians in selecting safer drug combinations as summarized here.
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Affiliation(s)
- Catalin Adrian Buzea
- Department 5 Internal Medicine, Carol Davila' University of Medicine and Pharmacy, Bucharest, Romania.,Cardiology, Clinical Hospital Colentina, Bucharest, Romania
| | - Lorena Dima
- Department of Fundamental Disciplines and Clinical Prevention, Faculty of Medicine, Transilvania University of Brasov, Brașov, Romania
| | - Christoph U Correll
- Department of Child and Adolescent Psychiatry, Charite Universitaetsmedizin, Berlin, Germany.,Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.,Department of Psychiatry, Zucker Hillside Hospital, Northwell Health System, Glen Oaks, NY, USA
| | - Peter Manu
- Department of Psychiatry, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.,Department of Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.,Medical Services, South Oaks Hospital, Northwell Health System, Amityville, NY, USA
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10
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Dose-Dependent Facial Edema Secondary to Olanzapine in a Medium-Long Stay Psychiatry Ward: Case Report and Review of Cases. J Clin Psychopharmacol 2022; 42:210-211. [PMID: 35230049 DOI: 10.1097/jcp.0000000000001502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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12
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Largeau B, Cracowski JL, Lengellé C, Sautenet B, Jonville-Béra AP. Drug-induced peripheral oedema: An aetiology-based review. Br J Clin Pharmacol 2021; 87:3043-3055. [PMID: 33506982 DOI: 10.1111/bcp.14752] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 01/15/2021] [Accepted: 01/21/2021] [Indexed: 12/24/2022] Open
Abstract
Many drugs are responsible, through different mechanisms, for peripheral oedema. Severity is highly variable, ranging from slight oedema of the lower limbs to anasarca pictures as in the capillary leak syndrome. Although most often noninflammatory and bilateral, some drugs are associated with peripheral oedema that is readily erythematous (eg, pemetrexed) or unilateral (eg, sirolimus). Thus, drug-induced peripheral oedema is underrecognized and misdiagnosed, frequently leading to a prescribing cascade. Four main mechanisms are involved, namely precapillary arteriolar vasodilation (vasodilatory oedema), sodium/water retention (renal oedema), lymphatic insufficiency (lymphedema) and increased capillary permeability (permeability oedema). The underlying mechanism has significant impact on treatment efficacy. The purpose of this review is to provide a comprehensive analysis of the main causative drugs by illustrating each pathophysiological mechanism and their management through an example of a drug.
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Affiliation(s)
- Bérenger Largeau
- CHRU de Tours, Service de Pharmacosurveillance, Centre Régional de Pharmacovigilance Centre-Val de Loire, Tours, 37044, France
| | | | - Céline Lengellé
- CHRU de Tours, Service de Pharmacosurveillance, Centre Régional de Pharmacovigilance Centre-Val de Loire, Tours, 37044, France
| | - Bénédicte Sautenet
- CHRU de Tours, Service de Néphrologie-Hypertension Artérielle, Dialyses et Transplantation Rénale, Tours, 37044, France.,Université de Tours, Université de Nantes, INSERM, methodS in Patients-centered outcomes and HEalth ResEarch (SPHERE) - UMR 1246, Tours, 37044, France
| | - Annie-Pierre Jonville-Béra
- CHRU de Tours, Service de Pharmacosurveillance, Centre Régional de Pharmacovigilance Centre-Val de Loire, Tours, 37044, France.,Université de Tours, Université de Nantes, INSERM, methodS in Patients-centered outcomes and HEalth ResEarch (SPHERE) - UMR 1246, Tours, 37044, France
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Clothiapine-Associated Peripheral Edema: A Case Report. Am J Ther 2021; 28:e147-e148. [PMID: 33369916 DOI: 10.1097/mjt.0000000000000970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Lurasidone, an atypical antipsychotic, is currently approved for treatment of schizophrenia and bipolar depression. Little is known about whether lurasidone might also cause pedal edema. A 55-year-old female patient had been diagnosed with bipolar I disorder from the age of 26. She had been prescribed escitalopram and quetiapine 300 mg/day for her persistent depressive mood. Later, she took lurasidone plus escitalopram to treat depressive episode. Consequently, she developed mild bilateral swelling over the lower legs and ankles. After lurasidone was discontinued, the bilateral pedal edema was completely resolved, and no further recurrence of edema occurred. Resolution of the edema after discontinuation of lurasidone indicates that the edema may have been caused by lurasidone. Caution should be needed when prescribing lurasidone for patients, as pedal edema may affect patients' adherence to the prescription.
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Cook EA, Shipman D, Fowler TG. Whole-body edema with olanzapine: A case report and literature review. Ment Health Clin 2020; 10:291-295. [PMID: 33062555 PMCID: PMC7534815 DOI: 10.9740/mhc.2020.09.291] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Olanzapine is a second-generation antipsychotic (SGA) that has been shown to promote disease remission in persons with treatment-resistant depression when used in combination with fluoxetine. However, tolerability of treatment augmentation with SGAs may be limited because of common adverse effects, such as weight gain, hypertriglyceridemia, and elevated glucose. Data exist pertaining to rare localized edematous reactions or angioedema with use of SGAs, but diffuse whole-body edema has yet to be documented. A 47-year-old white female with treatment-resistant depression presented with a 5-day history of weight gain and swelling of her torso and extremities. Five days prior, she had initiated olanzapine/fluoxetine 6/50 mg daily following failure of fluoxetine 40 mg daily monotherapy. The patient was noted to have gained 3.6 kg since her last appointment and exhibited profuse pitting edema on her forearms, lower limbs, hands, and chest. Olanzapine/fluoxetine was discontinued and the patient was prescribed a 3-day course of a loop diuretic for symptomatic management. A follow-up visit 5 days later noted complete resolution of symptoms. Because of the temporal relationship of symptoms with initiation of olanzapine, we recommend monitoring for edema with initiation and/or titration of therapy.
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Affiliation(s)
- Elizabeth A Cook
- Clinical Pharmacist Specialist, The Robert J. Dole Veteran Affairs Medical Center, Wichita, Kansas; previously: The University of Texas at Tyler, Ben and Maytee Fisch College of Pharmacy, Tyler, Texas,
| | - Denver Shipman
- Clinical Pharmacist Specialist, The Robert J. Dole Veteran Affairs Medical Center, Wichita, Kansas; previously: The University of Texas at Tyler, Ben and Maytee Fisch College of Pharmacy, Tyler, Texas
| | - Tyler Gipson Fowler
- PGY-1 Pharmacy Resident, Christus Trinity Mother Frances Hospital, Tyler, Texas; previously: The University of Texas at Tyler, Ben and Maytee Fisch College of Pharmacy, Tyler, Texas
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16
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Arslan M, Bulut Ü, Naki DD. Olanzapine Associated Acute Peripheral Edema and Pericardial Effusion: A Case Report. NORO PSIKIYATRI ARSIVI 2019; 56:79-81. [PMID: 30911243 DOI: 10.29399/npa.22860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 02/28/2018] [Indexed: 01/22/2023]
Abstract
Olanzapine is a potent atypical antipsychotic drug used for the treatment of schizophrenia and bipolar disorder with approved efficiency. Olanzapine is superior to the typical antipsychotic drugs with low incidence of extrapyramidal side effects, especially tardive dyskinesia. The most common side effects associated with olanzapine are constipation, dyspepsia, weight gain, somnolence, asthenia, dry mouth and dizziness. Peripheral edema associated with olanzapine is rarely reported and as far as we know there is no report in the literature about peripheral edema concomitant with pericardial effusion related to olanzapine. The mechanism of these side effects associated with olanzapine is still unclear and there are different hypotheses in the literature. Herein we report the first case that developed both peripheral edema and pericardial effusion after olanzapine administration. Although very rarely encountered, clinicians should be aware of these possible side-effects.
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Affiliation(s)
- Mehmet Arslan
- Department of Psychiatry, Kırklareli Babaeski State Hospital, Kırklareli, Turkey
| | - Ümit Bulut
- Department of Cardiology, Kırklareli Babaeski State Hospital, Kırklareli, Turkey
| | - Deniz Dilan Naki
- Department of Cardiology, Medipol University Faculty of Medicine, İstanbul, Turkey
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Subeesh V, Maheswari E, Singh H, Beulah TE, Swaroop AM. Novel Adverse Events of Iloperidone: A Disproportionality Analysis in US Food and Drug Administration Adverse Event Reporting System (FAERS) Database. Curr Drug Saf 2019; 14:21-26. [DOI: 10.2174/1574886313666181026100000] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 09/28/2018] [Accepted: 10/05/2018] [Indexed: 11/22/2022]
Abstract
Background:
The signal is defined as “reported information on a possible causal relationship
between an adverse event and a drug, of which the relationship is unknown or incompletely
documented previously”.
Objective:
To detect novel adverse events of iloperidone by disproportionality analysis in FDA
database of Adverse Event Reporting System (FAERS) using Data Mining Algorithms (DMAs).
Methodology:
The US FAERS database consists of 1028 iloperidone associated Drug Event
Combinations (DECs) which were reported from 2010 Q1 to 2016 Q3. We consider DECs for
disproportionality analysis only if a minimum of ten reports are present in database for the given
adverse event and which were not detected earlier (in clinical trials). Two data mining algorithms,
namely, Reporting Odds Ratio (ROR) and Information Component (IC) were applied retrospectively in
the aforementioned time period. A value of ROR-1.96SE>1 and IC- 2SD>0 were considered as the
threshold for positive signal.
Results:
The mean age of the patients of iloperidone associated events was found to be 44years [95%
CI: 36-51], nevertheless age was not mentioned in twenty-one reports. The data mining algorithms
exhibited positive signal for akathisia (ROR-1.96SE=43.15, IC-2SD=2.99), dyskinesia (21.24, 3.06),
peripheral oedema (6.67,1.08), priapism (425.7,9.09) and sexual dysfunction (26.6-1.5) upon analysis
as those were well above the pre-set threshold.
Conclusion:
Iloperidone associated five potential signals were generated by data mining in the FDA
AERS database. The result requires an integration of further clinical surveillance for the quantification
and validation of possible risks for the adverse events reported of iloperidone.
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Affiliation(s)
- Viswam Subeesh
- Department of Pharmacy Practice, Faculty of Pharmacy, M.S. Ramaiah University of Applied Sciences, Bengaluru, India
| | - Eswaran Maheswari
- Department of Pharmacy Practice, Faculty of Pharmacy, M.S. Ramaiah University of Applied Sciences, Bengaluru, India
| | - Hemendra Singh
- Department of Psychiatry, Ramaiah Medical College, Bengaluru, India
| | - Thomas Elsa Beulah
- Department of Pharmacy Practice, Faculty of Pharmacy, M.S. Ramaiah University of Applied Sciences, Bengaluru, India
| | - Ann Mary Swaroop
- Department of Pharmacy Practice, Faculty of Pharmacy, M.S. Ramaiah University of Applied Sciences, Bengaluru, India
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18
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Olanzapine associated palpebral edema: An uncommon adverse effect of a commonly prescribed drug. Asian J Psychiatr 2018; 36:60-61. [PMID: 29966888 DOI: 10.1016/j.ajp.2018.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 06/21/2018] [Indexed: 10/28/2022]
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19
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Kalambay J, Ghazanfar H, Martes Pena KA, Munshi RA, Zhang G, Patel JY. Pathogenesis of Drug Induced Non-Allergic Angioedema: A Review of Unusual Etiologies. Cureus 2017; 9:e1598. [PMID: 29067222 DOI: 10.7759/cureus.1598] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Angioedema is the swelling of mucosal and sub-mucosal tissue. Typically, it manifests as the swelling of the face, lips, and tongue. Angioedema can be severe and life threatening when it involves the respiratory tract. Drug induced allergic angioedema and drug induced non-allergic angioedema differ in their mediator, their clinical presentations, and their management. In drug induced non-allergic angioedema, symptoms are resistant to antihistamine and corticosteroid treatment. The aim of the analysis was to identify which medications are associated with drug-induced non-allergic angioedema and to understand the mechanism of action via which of these medication cause angioedema.
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Affiliation(s)
| | | | | | - Ruhul A Munshi
- Internal Medicine, Chittagong Medical College & Hospital
| | - George Zhang
- Internal Medicine, Shanghai Medical College, Fudan University
| | - Jay Y Patel
- Internal Medicine, Pramukhswami Medical College, Anand,Gujarat
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