RESUMO
HISTORY AND CLINICAL FINDINGS: A 43-year-old woman was admitted after a suicide attempt with 1.5 g atenolol. Physical and neurological examination showed no abnormality, but psychiatric examination revealed symptoms of a major depression. Four weeks prior to admission a valsartan-hydrochlorothiazide combination had been added to the antihypertensive medication. INVESTIGATIONS: Laboratory tests, electrocardiography, chest-x-ray, electroencephalography and cranial computerised tomography showed no abnormality. DIAGNOSIS AND COURSE: The depressive disorder resolved within ten days after discontinuation of valsartan and hydrochlorothiazide without specific treatment. Blood pressure was normal under treatment with metoprolol. CONCLUSION: Depressive drug reactions can produce a substantial morbidity. This case of a drug induced affective disorder should heighten the awareness of unusual reactions to valsartan-hydrochlorothiazide therapy.
Assuntos
Anti-Hipertensivos/efeitos adversos , Depressão/induzido quimicamente , Hidroclorotiazida/efeitos adversos , Tentativa de Suicídio , Tetrazóis/efeitos adversos , Valina/efeitos adversos , Adulto , Anti-Hipertensivos/uso terapêutico , Quimioterapia Combinada , Feminino , Humanos , Hidroclorotiazida/uso terapêutico , Hipertensão/tratamento farmacológico , Tetrazóis/uso terapêutico , Valina/análogos & derivados , Valina/uso terapêutico , ValsartanaRESUMO
Under antidepressive treatment with amitryptiline (100 mg/d) a 71-year old woman developed delirious symptoms, hyponatremia and a grand mal seizure followed by cardiovascular arrest. A few month later she ingested 48 mg reboxetine with suicidal intent. Overdosing of reboxetine, a selective noradrenaline re-uptake inhibitor, proceeded without complications.
Assuntos
Amitriptilina/efeitos adversos , Antidepressivos Tricíclicos/efeitos adversos , Antidepressivos/uso terapêutico , Morfolinas/uso terapêutico , Tentativa de Suicídio/psicologia , Idoso , Amitriptilina/uso terapêutico , Antidepressivos Tricíclicos/uso terapêutico , Feminino , Humanos , ReboxetinaRESUMO
For 15 years a now 70-year-old woman had been having occasional episodes of circulatory collapse which 7 years ago were diagnosed as being caused by severe idiopathic orthostatic hypotension. These episodes had recently become much more frequent and she was hardly able to be upright for more than one minute. In the Schellong test the blood pressure fell from 80/50 mm Hg when lying to 70/30 mm Hg on standing, the pulse rate remaining unchanged at 60/min. The standing test had to be abandoned after 90 seconds. Serum catecholamine concentrations (epinephrine 65 ng/l, norepinephrine 100 ng/l) did not rise on standing (epinephrine 25 ng/l, norepinephrine 105 ng/l). 24-hour urinary excretion of vanillyl mandelic acid was at the lower limit of normal (2.2 mg). The autonomic dysfunction of circulatory control suggested a Shy-Drager syndrome. Other signs of autonomic failure included gastroparesis, decreased tear and sweat secretion and transitory urinary incontinence. Symptomatic treatment with elastic stockings, fludrocortisone, etilefrine, dihydroergotamine, L-dopa, yohimbine and amezinium methylsulfate gave the patient greater mobility without achieving normal blood pressure responses.