ABSTRACT
Myopathy, including rhabdomyolysis, is a well-known, albeit rare complication of statin therapy. Predisposing factors include comorbidities and the concomitant use of cytochrome P-450 (CYP) 3A4 inhibitors. We report a case of severe simvastatin-induced rhabdomyolysis triggered by the addition of amiodarone to previously well-tolerated chronic statin therapy. Physicians should be aware of the risk of this potentially severe drug interaction. The dose of simvastatin should be reduced (to 20 mg daily) when concomitant treatment with amiodarone is required, or preference should be given to pravastatin, rosuvastatin or fluvastatin, which are not metabolised by the CYP 3A4.
Subject(s)
Amiodarone , Atrial Fibrillation/drug therapy , Cytochrome P-450 CYP3A/metabolism , Hypercholesterolemia/drug therapy , Rhabdomyolysis , Simvastatin , Aged, 80 and over , Amiodarone/administration & dosage , Amiodarone/adverse effects , Anti-Arrhythmia Agents/administration & dosage , Anti-Arrhythmia Agents/adverse effects , Atrial Fibrillation/complications , Atrial Fibrillation/physiopathology , Comorbidity , Creatine Kinase/blood , Dose-Response Relationship, Drug , Drug Interactions , Humans , Hypercholesterolemia/complications , Hypercholesterolemia/metabolism , Hypolipidemic Agents/administration & dosage , Hypolipidemic Agents/adverse effects , Inactivation, Metabolic , Male , Rhabdomyolysis/etiology , Rhabdomyolysis/metabolism , Rhabdomyolysis/therapy , Severity of Illness Index , Simvastatin/administration & dosage , Simvastatin/adverse effects , Treatment OutcomeABSTRACT
INTRODUCTION: This article proposes a review of atypical multicentre studies for drug-induced movement disorders (and related psychiatric symptoms) and supersensitivity psychosis. A well-conducted antipsychotic treatment consists of regular attempts to reduce the dose by finding the minimal therapeutic dose. To achieve optimal antipsychotic treatment, it is important to distinguish psychiatric symptoms associated with drug-induced movement disorder(s) (DIMD) or supersensitivity psychosis from true relapse. LITERATURE FINDINGS: Persistent DIMD have been found to be a predictor of supersensitivity psychosis or tardive dyskinesia (DT). DIMD-associated psychiatric symptoms can be classified into three types: directly induced by DIMD; resulting from confounding DIMD with psychiatric symptoms; and supersensitivity symptoms associated with DIMD. Without this distinction, the beneficial effects of antipsychotics are masked by emergent DIMD psychiatric symptoms (as was confounded in the CATIE study). DISCUSSION: A constant decline in the prevalence of TD (hyperkinetic, involuntary and purposeless movement disorder) has been observed since the introduction of atypical antipsychotics. The neurotoxic effects of classical antipsychotics are well documented and their discontinuation is required. However, the risk of TD still exits with atypical antipsychotics and continued surveillance of emerging cases is very important for clinicians. Moreover, a regular evaluation of DIMD and associated psychiatric symptoms is crucial. It is important to underline the fact that DIMD persists with antipsychotics, with significantly higher total PANSS scores than in patients without DIMD. CONCLUSION: Supersensitivity psychosis is a drug-induced psychotic relapse (6 weeks following the decrease or withdrawal of an antipsychotic). Discontinuation syndromes can produce psychiatric symptoms (and be confounded with true relapse), but can be improved more quickly after reintroduction of treatment. Interestingly, various data suggest that lower doses of antipsychotics could prevent such symptoms. Anticonvulsants can be efficient adjuvants in the treatment of psychosis. In the United States, many patients received valproate or gabapentin treatment. These adjuvants, by antikindling effect, can facilitate minimal maintenance drug treatment and be efficient for anxiety. Resistant schizophrenia can be related to supersensitivity psychosis; gabapentin and lamotrigine are effective in this case.
Subject(s)
Anticonvulsants/adverse effects , Antipsychotic Agents/adverse effects , Dyskinesia, Drug-Induced/diagnosis , Iatrogenic Disease , Psychoses, Substance-Induced/diagnosis , Psychotic Disorders/drug therapy , Anticonvulsants/therapeutic use , Antipsychotic Agents/therapeutic use , Dose-Response Relationship, Drug , Drug Therapy, Combination , Dyskinesia, Drug-Induced/psychology , Humans , Psychiatric Status Rating Scales , Psychoses, Substance-Induced/psychology , Psychotic Disorders/diagnosis , Psychotic Disorders/psychology , Risk FactorsABSTRACT
We report the case of a 46-year-old woman who noticed a swelling of the left supraclavicular fossa of rapid onset soon after a Mycoplasma Pneumoniae upper respiratory infection. On the basis of clinical history, physical examination and imaging findings, a diagnosis of chyloma due to intense non-productive coughing bouts was made. The supraclavicular swelling progressively disappeared after a few days. This observation prompted us to briefly review the pathophysiology of chylomas.
Subject(s)
Edema/microbiology , Mycoplasma pneumoniae , Pneumonia, Mycoplasma/complications , Pneumonia, Mycoplasma/pathology , Clavicle , Edema/diagnostic imaging , Edema/therapy , Female , Humans , Middle Aged , Pneumonia, Mycoplasma/therapy , RadiographyABSTRACT
In order to examine the genetic substrate of the dopamine hypothesis in restless legs syndrome, we analyzed eight genes coding for receptors and enzymes related to dopaminergic transmission, using a population of 92 patients with restless legs syndrome and 182 controls matched for ethnic background. No significant differences were found in the genotypic or allelic distributions between groups. Furthermore, no effect of the loci examined was observed with stratification using clinical parameters such as age at onset or periodic leg movements during sleep index.
