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Neurotoxicity and nephrotoxicity caused by combined use of lithium and risperidone: a case report and literature review

BACKGROUND: Combination lithium, a mood stabilizer, and risperidone, an atypical antipsychotic drug, is widely used for treatment of psychotic disorders. Rare reports concern severe adverse drug reaction in multiple organic systems with their combined use. We report two episodes of neurotoxicity and...

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Autores principales: Hsu, Chih-Wei, Lee, Yu, Lee, Chun-Yi, Lin, Pao-Yen
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5155382/
https://www.ncbi.nlm.nih.gov/pubmed/27964751
http://dx.doi.org/10.1186/s40360-016-0101-x
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author Hsu, Chih-Wei
Lee, Yu
Lee, Chun-Yi
Lin, Pao-Yen
author_facet Hsu, Chih-Wei
Lee, Yu
Lee, Chun-Yi
Lin, Pao-Yen
author_sort Hsu, Chih-Wei
collection PubMed
description BACKGROUND: Combination lithium, a mood stabilizer, and risperidone, an atypical antipsychotic drug, is widely used for treatment of psychotic disorders. Rare reports concern severe adverse drug reaction in multiple organic systems with their combined use. We report two episodes of neurotoxicity and nephrotoxicity in a patient following the combined use of lithium and risperidone. CASE PRESENTATION: A 55-year-old male had a diagnosis of schizoaffective disorder at the age of 51. He was initially treated with a combination of lithium and olanzapine 5 to 15 mg/day for 2 years. He was admitted to psychiatric ward at the age of 53 due to manic episode with psychotic feature. Because of poor blood sugar control, we switched olanzapine 20 mg/day to risperidone 4.5 mg/day with combination of lithium 900mg/day. The patient presented neurotoxicity, neuroleptic-malignant-syndrome like symptoms, and nephrotoxicity, elevation of blood creatinine and decreased urine output few days later. These signs were fully recovered within 2 days after we discontinued all medications and gave normal saline hydration. Then we re-administered decreased dosage of lithium 600 mg/day and risperidone 3 mg/day, and the similar episode occurred again 3 days later. All drugs were discontinued again, then his delirium resolved and abnormal data returned to normal 1 day later. Finally, the patient was treated with risperidone 2 mg/day as monotherapy, and no episode of neurotoxicity and nephrotoxicity appeared in the following 2 years. CONCLUSIONS: The case exemplifies neurotoxicity and nephrotoxicity after combined use of lithium and risperidone. These adverse effects resolved soon after discontinuing these medications and adequate hydration. Clinicians should be cautious about neurological and renal adverse effects.
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spelling pubmed-51553822016-12-20 Neurotoxicity and nephrotoxicity caused by combined use of lithium and risperidone: a case report and literature review Hsu, Chih-Wei Lee, Yu Lee, Chun-Yi Lin, Pao-Yen BMC Pharmacol Toxicol Case Report BACKGROUND: Combination lithium, a mood stabilizer, and risperidone, an atypical antipsychotic drug, is widely used for treatment of psychotic disorders. Rare reports concern severe adverse drug reaction in multiple organic systems with their combined use. We report two episodes of neurotoxicity and nephrotoxicity in a patient following the combined use of lithium and risperidone. CASE PRESENTATION: A 55-year-old male had a diagnosis of schizoaffective disorder at the age of 51. He was initially treated with a combination of lithium and olanzapine 5 to 15 mg/day for 2 years. He was admitted to psychiatric ward at the age of 53 due to manic episode with psychotic feature. Because of poor blood sugar control, we switched olanzapine 20 mg/day to risperidone 4.5 mg/day with combination of lithium 900mg/day. The patient presented neurotoxicity, neuroleptic-malignant-syndrome like symptoms, and nephrotoxicity, elevation of blood creatinine and decreased urine output few days later. These signs were fully recovered within 2 days after we discontinued all medications and gave normal saline hydration. Then we re-administered decreased dosage of lithium 600 mg/day and risperidone 3 mg/day, and the similar episode occurred again 3 days later. All drugs were discontinued again, then his delirium resolved and abnormal data returned to normal 1 day later. Finally, the patient was treated with risperidone 2 mg/day as monotherapy, and no episode of neurotoxicity and nephrotoxicity appeared in the following 2 years. CONCLUSIONS: The case exemplifies neurotoxicity and nephrotoxicity after combined use of lithium and risperidone. These adverse effects resolved soon after discontinuing these medications and adequate hydration. Clinicians should be cautious about neurological and renal adverse effects. BioMed Central 2016-12-14 /pmc/articles/PMC5155382/ /pubmed/27964751 http://dx.doi.org/10.1186/s40360-016-0101-x Text en © The Author(s). 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Case Report
Hsu, Chih-Wei
Lee, Yu
Lee, Chun-Yi
Lin, Pao-Yen
Neurotoxicity and nephrotoxicity caused by combined use of lithium and risperidone: a case report and literature review
title Neurotoxicity and nephrotoxicity caused by combined use of lithium and risperidone: a case report and literature review
title_full Neurotoxicity and nephrotoxicity caused by combined use of lithium and risperidone: a case report and literature review
title_fullStr Neurotoxicity and nephrotoxicity caused by combined use of lithium and risperidone: a case report and literature review
title_full_unstemmed Neurotoxicity and nephrotoxicity caused by combined use of lithium and risperidone: a case report and literature review
title_short Neurotoxicity and nephrotoxicity caused by combined use of lithium and risperidone: a case report and literature review
title_sort neurotoxicity and nephrotoxicity caused by combined use of lithium and risperidone: a case report and literature review
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5155382/
https://www.ncbi.nlm.nih.gov/pubmed/27964751
http://dx.doi.org/10.1186/s40360-016-0101-x
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