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Huang CC, Kuo SC, Chen CY, Yeh YW. Hypereosinophilia and Cognitive Impairment Induced by Mirtazapine. Am J Ther 2023:00045391-990000000-00145. [PMID: 37097041 DOI: 10.1097/mjt.0000000000001632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Affiliation(s)
- Chih-Chung Huang
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Hou WS, Tsai JP, Chiu YH, Lu ML. Carbamazepine-induced DRESS Syndrome: A Rare Delayed Hypersensitivity Reaction. J Psychiatr Pract 2022; 28:166-169. [PMID: 35238828 DOI: 10.1097/pra.0000000000000619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is a rare but severe cutaneous drug hypersensitivity reaction. Delays in making a diagnosis of DRESS syndrome and lack of timely treatment may result in morbidity and mortality. However, the presentation can be misinterpreted as other pathologies because of a broad spectrum of clinical presentations, delayed reactions, and prolonged course. Despite the discontinuation of the medication that is the culprit, relapses of drug reactions frequently occur weeks to months later. Several drugs that are associated with DRESS syndrome are prescribed as psychotropic medications. This report describes the case of a patient with DRESS syndrome who was evaluated with the RegiSCAR scoring system as a "definite case," which was possibly induced by carbamazepine prescribed to treat bipolar I disorder. The young female patient was successfully treated with steroid medication after carbamazepine was discontinued. She was prescribed aripiprazole for mood stabilization without a subsequent recurrence of DRESS syndrome. We recommend that, in cases such as described here, clinicians take DRESS syndrome into consideration and provide proper timely management, particularly for patients receiving psychotropic drugs. A brief review of the literature concerning DRESS syndrome associated with psychotropic drugs and its pathogenesis are outlined and discussed.
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Tsamakis K, Mueller C, Hortis I, Kallergi M, Tolos I, Alevyzakis E, Siafakas N, Ouranidis A, Tsiptsios D, Kympouropoulos S, Spandidos DA, Smyrnis N, Rizos E. Association of antipsychotic use with raised eosinophil count. Exp Ther Med 2021; 21:513. [PMID: 33791022 PMCID: PMC8005733 DOI: 10.3892/etm.2021.9944] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/26/2021] [Indexed: 01/20/2023] Open
Abstract
The current study aimed to assess the possibility of an association between first and second generation antipsychotic medication and raised eosinophil count. A total of 22 in-patients at the psychiatric unit of the University General Hospital ‘Attikon’, a tertiary hospital, were included in the present study. Patients had received antipsychotic monotherapy and did not have any co-morbidities or require additional treatments. Patients were monitored weekly and their eosinophil count was assessed. One-way ANOVA and summary measures analysis were applied to study the effect of time and medication type on the absolute eosinophil concentration (or relative percentage) for each patient. The differences in mean eosinophil concentrations or relative percentage by patient and time were also assessed. An increase in the absolute concentration and the relative percentage of eosinophils over time was observed in patients receiving Olanzapine, Haloperidol and Aripiprazole. However, there was no difference between individual medications. In conclusion, antipsychotics may be associated with increased eosinophil count over time; however, larger studies involving more patients and a longer follow-up are required to reach a definitive conclusion.
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Affiliation(s)
- Konstantinos Tsamakis
- Second Department of Psychiatry, University General Hospital 'Attikon', National and Kapodistrian University of Athens, Athens 12462, Greece.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
| | - Christoph Mueller
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK.,South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK
| | - Ioannis Hortis
- Second Department of Psychiatry, University General Hospital 'Attikon', National and Kapodistrian University of Athens, Athens 12462, Greece
| | - Maria Kallergi
- Department of Biomedical Engineering, University of West Attica, Campus I, Athens 12243, Greece
| | - Ioannis Tolos
- Second Department of Psychiatry, University General Hospital 'Attikon', National and Kapodistrian University of Athens, Athens 12462, Greece
| | - Evangelos Alevyzakis
- Second Department of Psychiatry, University General Hospital 'Attikon', National and Kapodistrian University of Athens, Athens 12462, Greece
| | - Nikolaos Siafakas
- Second Laboratory of Microbiology, University General Hospital 'ATTIKON', National and Kapodistrian University of Athens, Medical School, Athens 12462, Greece
| | - Andreas Ouranidis
- Department of Pharmaceutical Technology, School of Pharmacy, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece
| | - Dimitrios Tsiptsios
- Department of Neurophysiology, South Tyneside and Sunderland NHS Foundation Trust, Sunderland SR47TP, UK
| | - Stylianos Kympouropoulos
- Second Department of Psychiatry, University General Hospital 'Attikon', National and Kapodistrian University of Athens, Athens 12462, Greece
| | - Demetrios A Spandidos
- Laboratory of Clinical Virology, School of Medicine, University of Crete, Heraklion 71003, Greece
| | - Nikolaos Smyrnis
- Second Department of Psychiatry, University General Hospital 'Attikon', National and Kapodistrian University of Athens, Athens 12462, Greece
| | - Emmanouil Rizos
- Second Department of Psychiatry, University General Hospital 'Attikon', National and Kapodistrian University of Athens, Athens 12462, Greece
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The Effect of Valproic Acid on Olanzapine Serum Concentration: A Study Including 2791 Patients Treated With Olanzapine Tablets or Long-Acting Injections. J Clin Psychopharmacol 2020; 39:561-566. [PMID: 31688390 DOI: 10.1097/jcp.0000000000001126] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND The combination of olanzapine and valproic acid (VPA) is regularly prescribed in the treatment of bipolar or schizoaffective disorders. The VPA has been shown to reduce olanzapine concentration, but the mechanism behind this interaction remains unknown. We aimed to investigate the effect of VPA on olanzapine concentration during oral versus long-acting injectable (LAI) formulation in a real-life setting. METHODS From a therapeutic drug monitoring service, prescribed doses and serum concentrations from 2791 olanzapine-treated patients (9433 measurements) were included. RESULTS The number of patients on olanzapine-LAI treatment was 328, whereas 2463 were using oral olanzapine. The frequency of patients comedicated with VPA was 9.4% for olanzapine tablets and 5.8% for olanzapine-LAI. The VPA had no effect on olanzapine dose-adjusted concentrations in LAI users (1.6 vs 1.7 [ng/mL]/[mg/d]; P = 0.38), whereas in the oral group the dose-adjusted olanzapine concentration was lower in VPA users (2.2 vs 2.7 [ng/mL]/[mg/d]; P < 0.001). For smokers in the oral olanzapine group using VPA, 8.7% of the measurements were in the subtherapeutic range (<10 ng/mL) compared with 6.0% in nonusers (P = 0.003). IMPLICATIONS These findings show that the VPA-olanzapine interaction involves a presystemic mechanism and is therefore restricted to oral olanzapine treatment. For oral treatment of olanzapine, comedication with VPA implies a risk of insufficient effect, which may be of clinical relevance in smokers in particular. Thus, it is important to be aware of the interaction potential with VPA during oral olanzapine use, whereas for LAI-treated patients fewer precautions are required from a pharmacokinetic point of view.
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Lai TJ, Lin YP, Tsai YY. Olanzapine-associated asymptomatic eosinophilia: A case report. TAIWANESE JOURNAL OF PSYCHIATRY 2020. [DOI: 10.4103/tpsy.tpsy_18_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Gowda SM, Vijay Kumar KG, Shilpa K. Chlorpromazine-induced Drug Reaction with Eosinophilia and Systemic Symptoms Syndrome. Indian J Psychol Med 2020; 42:99-101. [PMID: 31997872 PMCID: PMC6970299 DOI: 10.4103/ijpsym.ijpsym_364_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 09/30/2019] [Accepted: 12/13/2019] [Indexed: 11/18/2022] Open
Affiliation(s)
- Shayanth Manche Gowda
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - K G Vijay Kumar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - K Shilpa
- Department of Dermatology, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
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A Rare Presentation of Clozapine-Induced DRESS Syndrome. Case Rep Med 2018; 2018:1346351. [PMID: 29991947 PMCID: PMC6016221 DOI: 10.1155/2018/1346351] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 04/16/2018] [Indexed: 11/18/2022] Open
Abstract
Drug reaction with eosinophilia and systemic symptoms (DRESS syndrome) is an uncommon side effect of certain medications. It causes a skin reaction, with eosinophilia and other organ involvement. This case describes a presentation of a 32-year-old female with a past medical history significant for schizophrenia and bipolar disorder who presented for a rash. She had been started on clozapine 10 days prior to admission. After extensive workup she was found to have DRESS syndrome secondary to clozapine use. This is the second reported case in the literature of clozapine-induced DRESS syndrome. This case is unique because it is the first case to present with the common manifestations of DRESS syndrome including eosinophilia, rash, lymphadenopathy, and organ involvement after clozapine use.
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