Severe extrapyramidal symptoms due to sulpiride and fluoxetine combination in a case of OCD

Sülpirid ve fluoksetin'in birlikte kullanımına bağlı olarak şiddetli ekstrapiramidal yan etki ortaya çıkan bir OKB olgusu

Özet

Düşük dozlarda kullanılan sülpiridin antidepresan etkinlik gösterdiği bilinmektedir. Obsesif kompulsif bozukluğun (OKB) tedavisinde düşük dozlarda antidepresan ilaçlarla birlikte kullanılabilmektedir. DSM-V'e göre OKB ve majör depresyon tanısı konan 53 yaşında bayan hasta. 6 yıldır süren OKB'u, 6 aydır süren depresyonu var. Dirençli OKB olarak kabul edilen ve has-taneye yatırılan hastaya 20 mg/gün fluoksetin başlandı. 1 hafta sonra doz 40 mg'a yükseltildi ve 200 mg sülpirid eklendi. Tedavinin 3. gününde şiddetli ekstrapiramidal yan etkiler ortaya çıktı. Bunun üzerine sülpirid kesildi. Fluoksetin dozu 20 mg'a inil-di. Tedaviye 100 mg/gün difenhidremin, 40 mg/gün propra-nolol ve 10 mg/gün diazepam eklendi. Bir hafta içinde çiğneme hareketleri dışındaki ekstra piramidal sistem belirtilerinde belirgin düzelme gözlendi.

Abstract

Sulpiride is an antipsychotic agent which has an antidepressant effect in low doses. The Combination of antipsychotics in lovver dosages with antidepressants in obsessive-compulsive disorder (OCD) patients has also been reported to be useful. The case reported was a 53 years old female patient with OCD and majör depression according to the DSM-IV diagnostic criteria. OCD diagnosis was preseni for six years and she had been depressied for the last six months. She was accepted as having resistant OCD according to the patient's history. After she was hospitalized, the treatment began with fluoksetin 20 mg/day. in the second week fluoksetin dosage was raised to 40 mg/day and 200 mg/day sulpiride was added. On the third day of com-bination treatment, severe extrapyramidal symptoms emerged and this prompted us to quit the use of sulpiride. Biperiden 3 mg/day was ordered in order to relieve those side effects. As these precautions were not efficacious, fluoksetin dosage was lowered to 20 mg/day, and then it was quitted. Diphenhidramine 100 mg/day, propranolol 40 mg/day and diazepam 10 mg/day were ordered. Except chewing move-ments extrapyramidal symptoms lasted for a week.