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Case report: Extrapontine myelinolysis combined with flupentixol- and melitracen-induced dysphagia

Extrapontine myelinolysis (EPM) is a rare symmetrical demyelinating disease of the central nervous system, which is often accompanied with central pontine myelinolysis (CPM) or can appear alone. A combination of flupentixol and melitracen is used as an antianxiety–antidepressant drug which may induc...

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Autores principales: Zhao, Zhihong, Han, Lu, Zhu, Zilong
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10618675/
https://www.ncbi.nlm.nih.gov/pubmed/37920206
http://dx.doi.org/10.3389/fphar.2023.1266296
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author Zhao, Zhihong
Han, Lu
Zhu, Zilong
author_facet Zhao, Zhihong
Han, Lu
Zhu, Zilong
author_sort Zhao, Zhihong
collection PubMed
description Extrapontine myelinolysis (EPM) is a rare symmetrical demyelinating disease of the central nervous system, which is often accompanied with central pontine myelinolysis (CPM) or can appear alone. A combination of flupentixol and melitracen is used as an antianxiety–antidepressant drug which may induce hyponatremia. Herein, we report a 46-year-old woman with depression who was treated with flupentixol and melitracen 0.5/10 mg once daily for 6 months. Later, the dosage increased to 0.5/10 mg twice daily. At the same time, she had complains of intermittent dizziness and fatigue. The laboratory test revealed hyponatremia (121 mmol/L). Dizziness was improved after sodium supplementation, with an increase in blood sodium to 133 mmol/L. Twenty days later, she had difficulty opening the mouth and swallowing, needing a gastric tube due to severe dysphagia. Head magnetic resonance imaging (MRI) showed a symmetric abnormal signal of caudate nucleus and lenticular nuclei. The symptoms were not relieved after active treatment, such as rehydration. However, her symptoms improved significantly after discontinuation of flupentixol and melitracen and switching to promethazine. Follow-up head MRI after 4 months revealed no abnormal signals. The patient who developed EPM had dysphagia, despite appropriate correction of hyponatremia. Flupentixol and melitracen can cause hyponatremia and dysphagia. This case highlights an unexpected association between EPM and flupentixol- and melitracen-induced dysphagia.
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spelling pubmed-106186752023-11-02 Case report: Extrapontine myelinolysis combined with flupentixol- and melitracen-induced dysphagia Zhao, Zhihong Han, Lu Zhu, Zilong Front Pharmacol Pharmacology Extrapontine myelinolysis (EPM) is a rare symmetrical demyelinating disease of the central nervous system, which is often accompanied with central pontine myelinolysis (CPM) or can appear alone. A combination of flupentixol and melitracen is used as an antianxiety–antidepressant drug which may induce hyponatremia. Herein, we report a 46-year-old woman with depression who was treated with flupentixol and melitracen 0.5/10 mg once daily for 6 months. Later, the dosage increased to 0.5/10 mg twice daily. At the same time, she had complains of intermittent dizziness and fatigue. The laboratory test revealed hyponatremia (121 mmol/L). Dizziness was improved after sodium supplementation, with an increase in blood sodium to 133 mmol/L. Twenty days later, she had difficulty opening the mouth and swallowing, needing a gastric tube due to severe dysphagia. Head magnetic resonance imaging (MRI) showed a symmetric abnormal signal of caudate nucleus and lenticular nuclei. The symptoms were not relieved after active treatment, such as rehydration. However, her symptoms improved significantly after discontinuation of flupentixol and melitracen and switching to promethazine. Follow-up head MRI after 4 months revealed no abnormal signals. The patient who developed EPM had dysphagia, despite appropriate correction of hyponatremia. Flupentixol and melitracen can cause hyponatremia and dysphagia. This case highlights an unexpected association between EPM and flupentixol- and melitracen-induced dysphagia. Frontiers Media S.A. 2023-10-18 /pmc/articles/PMC10618675/ /pubmed/37920206 http://dx.doi.org/10.3389/fphar.2023.1266296 Text en Copyright © 2023 Zhao, Han and Zhu. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Pharmacology
Zhao, Zhihong
Han, Lu
Zhu, Zilong
Case report: Extrapontine myelinolysis combined with flupentixol- and melitracen-induced dysphagia
title Case report: Extrapontine myelinolysis combined with flupentixol- and melitracen-induced dysphagia
title_full Case report: Extrapontine myelinolysis combined with flupentixol- and melitracen-induced dysphagia
title_fullStr Case report: Extrapontine myelinolysis combined with flupentixol- and melitracen-induced dysphagia
title_full_unstemmed Case report: Extrapontine myelinolysis combined with flupentixol- and melitracen-induced dysphagia
title_short Case report: Extrapontine myelinolysis combined with flupentixol- and melitracen-induced dysphagia
title_sort case report: extrapontine myelinolysis combined with flupentixol- and melitracen-induced dysphagia
topic Pharmacology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10618675/
https://www.ncbi.nlm.nih.gov/pubmed/37920206
http://dx.doi.org/10.3389/fphar.2023.1266296
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