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Ismail NE, Jha AN, Goh KW, Ming LC, Wahab MSA, Shah NJ, Shah AH, Hermansyah A. Self-assumed Neurologic Related Condition Deviated Metoclopramide-Induced Acute Dystonic of Oculogyric Crisis in a Woman of Childbearing Age: A Case Report. J Pharmacol Pharmacother 2023. [DOI: 10.1177/0976500x221142377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
A 26-year-old Malaysian woman (childbearing age) attended a private primary care clinic with a known case of gastroesophageal reflux disease (GERD) and complained of persistent nausea and a few episodes of vomiting. She had no known drug allergy, no surgical history, no hospitalization in the last two years, was a non-smoker, and no history of drug or alcohol abuse. The patient was prescribed Tab metoclopramide 10 mg TDS and Tab ranitidine 150 mg BD for five days. About 30 min after oral administration of both medicines, her eyes rolled involuntary upward, leading to lateral deviation of the eyes, and mouth jaws clenched as if “dislocated jaws.” The patient was immediately brought into an emergency department (ED) of a public tertiary care hospital. A drug challenge test was done which resulted in the withdrawal of metoclopramide. The accompanied sister later disclosed that the patient had taken metoclopramide and ranitidine from a private clinic earlier in the day. The patient self-assumed to have a sudden seizure, due to excessive hot weather and dehydration. A slow intravenous infusion of 50 mg/mL diphenhydramine hydrochloride in 0.9% w/v NaCl 100 mL was administered stat. Consequently, the symptoms vanished after approximately 30 min of the therapy, devoid of relapse. The patient was discharged from ED post 8 hours of monitoring with complete recovery. Physicians frequently prescribe metoclopramide to treat nausea and vomiting, which may cause adverse drug reaction of acute dystonic oculogyric crisis (OGC). Due to its unwanted and unpredictable extrapyramidal symptoms, metoclopramide should be prescribed and dispensed with caution. Thorough history taking at ED is imperative for correct early diagnosis and treatment, as metoclopramide-induced dystonic OGC has a high probability of confusion with other causes of dystonia such as conversion and seizures, encephalitis, tetanus, and hypercalcemic tetany.
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Affiliation(s)
| | - Ambika Nand Jha
- Department of Pharmacy Practice, Indubhai Patel College of Pharmacy and Research Centre, Gujarat, India
| | - Khang Wen Goh
- Faculty of Data Science and Information Technology, INTI International University, Nilai, Malaysia
| | - Long Chiau Ming
- Pengiran Anak Puteri Rashidah Sa’adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam, Gadong, Brunei Darussalam
- Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia
- School of Medical and Life Sciences, Sunway University, Sunway City, Selangor, Malaysia
| | - Mohd Shahezwan Abd. Wahab
- Department of Pharmacy Practice, Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam Campus, Bandar Puncak Alam, Malaysia
| | - Nehal J. Shah
- Department of Pharmaceutical Chemistry, Indubhai Patel College of Pharmacy and Research Centre, Gujarat, India
| | - Akshay H. Shah
- Department of Pharmacology, Indubhai Patel College of Pharmacy and Research Centre, Gujarat, India
| | - Andi Hermansyah
- Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia
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Ghosh A, Shah R, Naskar C, Prasad S, Sharma N. Dystonia after Shooting Street Heroin: An Underreported Matter of Concern. Indian J Psychol Med 2019; 41:588-591. [PMID: 31772449 PMCID: PMC6875830 DOI: 10.4103/ijpsym.ijpsym_193_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Abhishek Ghosh
- Department of Psychiatry, Drug Deaddiction and Treatment Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Raghav Shah
- Department of Psychiatry, Drug Deaddiction and Treatment Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Chandrima Naskar
- Department of Psychiatry, Drug Deaddiction and Treatment Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sambhu Prasad
- Department of Psychiatry, Drug Deaddiction and Treatment Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nidhi Sharma
- Department of Psychiatry, Drug Deaddiction and Treatment Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Agass RF, Brennan M, Rendle DI. Extrapyramidal side effects following subcutaneous metoclopramide injection for the treatment of post operative ileus. EQUINE VET EDUC 2017. [DOI: 10.1111/eve.12586] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- R. F. Agass
- Rainbow Equine Hospital; Old Malton Malton North Yorkshire UK
| | - M. Brennan
- Rainbow Equine Hospital; Old Malton Malton North Yorkshire UK
| | - D. I. Rendle
- Rainbow Equine Hospital; Old Malton Malton North Yorkshire UK
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Barow E, Schneider SA, Bhatia KP, Ganos C. Oculogyric crises: Etiology, pathophysiology and therapeutic approaches. Parkinsonism Relat Disord 2017; 36:3-9. [DOI: 10.1016/j.parkreldis.2016.11.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 10/27/2016] [Accepted: 11/21/2016] [Indexed: 12/14/2022]
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Phencyclidine Induced Oculogyric Crisis Responding Well to Conventional Treatment. Case Rep Emerg Med 2015; 2015:506301. [PMID: 26101673 PMCID: PMC4460230 DOI: 10.1155/2015/506301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 05/10/2015] [Accepted: 05/18/2015] [Indexed: 12/03/2022] Open
Abstract
Background. Oculogyric crisis is a form of acute dystonic reaction characterized by involuntary upward deviation of eye ball. Its causes are broad with antipsychotics and antiemetics as the most common causes. Case Presentation. A 25-year-old man with the past medical history of marijuana use presented to ED with involuntary upward deviation of eye 1 day after using phencyclidine (PCP) for the first time. He did not have any other symptoms and was hemodynamically stable. All laboratory investigations were normal except urine drug screen which was positive for PCP. Patient was treated with IV diphenhydramine which improved his symptoms. Conclusion. Illicit drug abuse is a growing problem in our society with increasingly more patients presenting to ED with its complications. The differential diagnosis of acute dystonic reactions should be extended to include illicit drugs as the potential cause of reversible acute dystonias especially in high risk patients.
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Baird JD, Arroyo LG, Vengust M, McGurrin MKJ, Rodriguez-Palacios A, Kenney DG, Aravagiri M, Maylin GA. Adverse extrapyramidal effects in four horse given fluphenazine decanoate. J Am Vet Med Assoc 2006; 229:104-10. [PMID: 16817724 DOI: 10.2460/javma.229.1.104] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CASE DESCRIPTION 4 racehorses were examined because of markedly abnormal behavior following administration of fluphenazine decanoate. CLINICAL FINDINGS Clinical signs included restlessness, agitation, profuse sweating, hypermetria, aimless circling, intense pawing and striking with the thoracic limbs, and rhythmic swinging of the head and neck alternating with episodes of severe stupor. Fluphenazine was detected in serum or plasma from all 4 horses. The dose of fluphenazine decanoate administered to 3 of the 4 horses was within the range (25 to 50 mg) routinely administered to adult humans. TREATMENT AND OUTCOME In 2 horses, there was no response to IV administration of diphenhydramine hydrochloride, but the abnormal behavior in these 2 horses appeared to resolve following administration of benztropine mesylate, and both horses returned to racing. The other 2 horses responded to diphenhydramine administration. One returned to racing. The other was euthanized because of severe neurologic signs, respiratory failure, and acute renal failure. CLINICAL RELEVANCE Findings indicate that adverse extrapyramidal effects may occur in horses given fluphenazine decanoate. These effects appear to be unpredictable and may be severe and life threatening. Use of fluphenazine decanoate as an anxiolytic in performance horses is not permitted in many racing and horse show jurisdictions, and analytic procedures are now available to detect the presence of fluphenazine in serum or plasma.
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Affiliation(s)
- John D Baird
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario N1G 2W1, Canada
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King H, Corry P, Wauchob T, Barclay P. Probable dystonic reaction after a single dose of cyclizine in a patient with a history of encephalitis. Anaesthesia 2003; 58:257-60. [PMID: 12603456 DOI: 10.1046/j.1365-2044.2003.03038.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A patient underwent an emergency Caesarean section under general anaesthesia for an antepartum haemorrhage. Following delivery of a live infant, cyclizine was administered in accordance with departmental anti-emetic protocol. On awakening she was confused, slow to articulate and had slurred speech. A computed tomography (CT) scan, which was performed to exclude an intracranial event, was normal. Her symptoms were suggestive of a lingual-facial-buccal dyskinesia as seen with dopamine antagonists. A presumptive diagnosis of a dystonic reaction to cyclizine was made. She received two doses of procyclidine before her symptoms completely resolved. Cyclizine has had a resurgence in popularity owing to the recent withdrawal of droperidol and anaesthetists should be aware that, although extremely rare, dystonic reactions may occur with this agent.
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Affiliation(s)
- H King
- Liverpool Women's Hospital, Crown Street, Liverpool L8 7SS, UK
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Schramm BM, Orser BA. Dystonic reaction to propofol attenuated by benztropine (cogentin). Anesth Analg 2002; 94:1237-40, table of contents. [PMID: 11973196 DOI: 10.1097/00000539-200205000-00034] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
IMPLICATIONS Neuroexcitatory movements associated with propofol anesthesia are well recognized. Here we report on the successful use of benztropine (2 mg) to abolish abnormal dystonic movements after propofol anesthesia. Forty-five case reports are reviewed, and a treatment strategy for abnormal movements during propofol anesthesia is provided.
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Affiliation(s)
- Belinda M Schramm
- Department of Anaesthesia, Sunnybrook & Women's College Health Sciences Centre, University of Toronto, Ontario, Canada
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Russell SA, Hennes HM, Herson KJ, Stremski ES. Upper airway compromise in acute chlorpromazine ingestion. Am J Emerg Med 1996; 14:467-8. [PMID: 8765112 DOI: 10.1016/s0735-6757(96)90154-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
A 16-year-old boy developed symptoms of acute upper airway compromise after chlorpromazine ingestion. The patient took six 100-mg Thorazine tablets "to help him sleep". Laryngeal-pharyngeal dystonia is a life-threatening form of dystonic reaction that is dose-dependent. In children, acute upper airway compromise should raise the suspicion of exposure to phenothiazines.
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Affiliation(s)
- S A Russell
- Medical College of Wisconsin, Milwaukee, USA
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Marken PA, Wells BG, Brown CS. Treatment of psychosis in pregnancy. DICP : THE ANNALS OF PHARMACOTHERAPY 1989; 23:598-600. [PMID: 2763583 DOI: 10.1177/1060028089023007-815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- P A Marken
- Division of Pharmacy Practice, University of Missouri, Kansas City 68104
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Abstract
A 20-year-old woman presented with an apparent acute dystonic reaction after only five doses of cimetidine (Tagamet). The patient was on no other medications with the exception of oral contraceptives. Emergency administration of IV diphenhydramine HCL brought rapid reversal of this acute dystonic reaction without any neurological sequelae. To our knowledge, this is the first reported case of an acute dystonic reaction associated with cimetidine.
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Affiliation(s)
- S Romisher
- Department of Emergency Medicine, Akron General Hospital, Ohio
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12
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Abstract
Four patients presented to the emergency department with acute dystonic reactions 36 hours after the ingestion of "Valium tablets" they purchased on the street. Complete reversal of the symptomatology was achieved with the use of intramuscular diphenhydramine. The pathophysiology, epidemiology, and treatment principles for dystonic reactions are discussed.
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Bailie GR, Nelson MV, Krenzelok EP, Lesar T. Unusual treatment response of a severe dystonia to diphenhydramine. Ann Emerg Med 1987; 16:705-8. [PMID: 3578980 DOI: 10.1016/s0196-0644(87)80077-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
A 27-year-old man was admitted to the emergency department with a fluphenazine decanoate-induced dystonia. He was treated with 125 mg diphenhydramine IV in four doses and 2 mg benztropine IM. A fluctuating response was observed before continued remission of the dystonia. Possible reasons for variable patient responses to diphenhydramine are discussed.
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Hurd PD, Butkovich SL. Compliance problems and the older patient: assessing functional limitations. DRUG INTELLIGENCE & CLINICAL PHARMACY 1986; 20:228-31. [PMID: 3956383 DOI: 10.1177/106002808602000312] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A procedure to assess functional abilities that can make compliance difficult for the older individual is described. The test can be constructed from items commonly found in the pharmacy. It has been designed to assist the pharmacist in identifying problems older individuals will have in taking their medications. The problems include label-reading, color vision, child-resistant containers, short-term memory, and label interpretation. The procedure identified more functional limitations in a sample of 14 older individuals than in a sample of younger individuals.
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Abstract
Dystonic reactions to neuroleptic and antiemetic medications are commonly seen in the outpatient setting. Despite initially successful treatment in the emergency department, symptoms may later recur. We have recently seen several cases of recurrent dystonic reactions; four representative cases are reported. Three of the patients experienced no further dystonic reactions when treated appropriately as outpatients. The fourth patient was lost to follow up. Based on this experience in the pharmacology of the drugs involved in producing and treating dystonic reactions, it is recommended that patients successfully treated in the emergency department for dystonia receive continued outpatient therapy for 48 to 72 hours.
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Treatment of acute phenothiazine reaction. Ann Emerg Med 1981. [DOI: 10.1016/s0196-0644(81)80172-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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