2 results
A case of phentermine-induced psychosis: the need for caution for drug-drug interactions
- S. Sreevalsam Anil, M. Thootkur, J. White
-
- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S1015-S1016
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Introduction
Phentermine is a sympathomimetic amine that the U.S Food and Drug Administration has approved for short-term use in the treatment of obesity. However, there have been case reports of phentermine being associated with neuropsychiatric symptoms, and thus caution is needed to avoid drug-drug interactions when prescribing phentermine (Nathan PJ, et al. CNS Neurosci Ther 2011;17:490-505) We present a case of phentermine-induced psychosis that could have been precipitated after being co-prescribed with fluoxetine.
ObjectivesTo discuss a case of phentermine-induced psychosis that could have been precipitated by CYP3A4 inhibition of phentermine by fluoxetine.
MethodsMiss X is a 61-year-old female with a history of major depressive disorder, generalized anxiety disorder, obesity, and rheumatoid arthritis. Her psychiatric symptoms were stable with oral fluoxetine 60 mg daily, oral aripiprazole 2mg daily, oral amitriptyline 100mg at night, and oral lorazepam 1mg daily. Miss X was prescribed oral phentermine 15mg daily for appetite suppression for weight loss. Subsequently, she started developing paranoid delusions against her family members, generalized anxiety, increased psychomotor activity, decreased appetite, and decreased sleep. Her symptoms continued to worsen even after discontinuing her medications on the 7th day. Miss X was eventually brought to the emergency room on the 14th day as her symptoms continued to deteriorate and she could not take care of herself.
ResultsMiss X’s symptoms resolved after a dose of Intramuscular injection of 2mg of lorazepam. No signs of serotonin syndrome were present during the examination. Drug-drug interaction between phentermine and fluoxetine is suspected to be a causative factor in the precipitation of psychosis as fluoxetine can inhibit the CYP3A4 metabolism of phentermine. Her electrocardiogram also demonstrated prolonged QTc (470ms), which could have been precipitated by co-prescribing phentermine and amitriptyline. Miss X was admitted to the inpatient psychiatric unit, and oral fluoxetine 60mg daily, oral aripiprazole 2mg daily, and oral lorazepam 1mg daily were restarted. Due to QTc prolongation oral trazodone 50mg daily was started instead of amitriptyline. After her psychiatric symptoms were stable on the medication regimen, Miss X was discharged on the third day of admission to the inpatient psychiatric unit.
ConclusionsOur case demonstrates the caution needs to be taken when prescribing phentermine not only for its neuropsychiatric side-effects but also for drug-drug interactions.
Disclosure of InterestNone Declared
A Case Report of Low-Dose Steroid Induced Psychosis in an Older Adult with Rheumatoid Arthritis
- N. Edokobi, S. Sreevalsam Anil, J. Wells
-
- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S233
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Introduction
Rheumatoid arthritis (RA) is typically known for its intra-articular manifestations in the joints, and steroids are considered one of the first-line medications for it. Steroids are known for neuropsychiatric manifestations, but it is rarely reported in low-dose steroids.
ObjectivesWe describe a case of psychosis in an older adult with RA precipitated by low-dose prednisone with no past history of neuropsychiatric symptoms from steroids in the past five years.
MethodsMiss X is a 63-year-old female with past history of RA, major depressive disorder, hypothyroidism, chronic obstructive pulmonary disease, and hypertension, presented with one-week history of irritable mood, increased psychomotor agitation, decreased need for sleep and appetite, and delusions of grandeur and persecution. Her depression had been treated with oral duloxetine 60mg twice daily, oral buspirone 10mg at night, and oral trazodone 150mg at night. She did have a urinary tract infection a week prior, but the psychotic symptoms persisted with antibiotic treatment. Miss X had also been on a monthly taper regimen of low-dose oral prednisone for RA (from 15mg to 5mg) for the past three months and had completed the regimen one week ago. On mental status examination, she was alert and oriented to time, place, and person. Her mood was irritable with lability. She demonstrated tangential speech along with persecutory and grandiose delusions. Attention and concentration was normal with intact immediate and remote memory and impaired recent memory. Abstract ability, judgment, and insight were impaired. Physical examination and vital signs were within normal limits. Laboratory investigations of complete blood count, urine analysis, urine drug screen, thyroid function panel, renal function panel, hepatic function panel, serum sodium, potassium, calcium, thiamine, vitamin B12, folate, and vitamin D did not show any significant abnormalities.
ResultsMiss X was admitted to the inpatient psychiatric unit with the diagnosis of medication-induced psychotic disorder, with onset after medication use as per The Diagnostic and Statistical Manual of Mental Disorders 5th edition- Text Revision. Oral olanzapine 10mg at night and oral lithium 300mg twice daily was started along with her home medications of oral duloxetine 60 mg twice daily and oral trazodone 150mg at night. During hospital stay, oral olanzapine was gradually increased to 15mg in the night but had to be reduced back to 10mg in the night due to sedation. Miss X’s symptoms improved during hospital stay and she was discharged on the 13th day of hospitalization with the same psychotropic medication regimen.
ConclusionsOur case demonstrates the need for caution in prescribing steroids in older adults as it can precipitate neuropsychiatric symptoms even with a change in use or after withdrawal of steroids.
Disclosure of InterestNone Declared