Ibrahim YAGCİ, Yasin TAŞDELEN, YÜKSEL KIVRAK

Klonazepam kullanımı sonucu akut solunum depresyonu: Olgu sunumu

Bipolar duygulanım bozukluğu sık görülen psikiyatrik bozukluklardan biridir. Benzodiyazepinler maninin tedavisinde antipsikotiklere ek olarak kullanılabilir. Tedaviye klonazepam veya lorazepam gibi bir benzodiyazepin eklenmesi, akut nöbet tedavisinin daha hızlı ve etkili olmasını sağlar. Benzodiyazepinlerin özellikle parenteral yüksek doz kullanımı solunum depresyonu yapabilmektedir. Bildiğimiz kadarı ile psikiyatrik bozukluk dışında başka hastalığı olmayan bir kişide, sadece olanzapin ve klonazepam kullanımına bağlı, yoğun bakımda izlemeye alınmasına gerek görülecek kadar solunum depresyonu gelişen olgu bildirimi yoktur. Bu yazıda manik nöbet tanısı ile olanzapin 10 mg/gün ile tedaviye başlanılan ve klonazepam 2 mg/gün verilmesinden sonra solunum depresyonu gelişen bir olgu sunulmuştur.

Acute respiratory depression due to treatment with clonazepam: a case report

Bipolar disorder is one of the most common psychiatric disorders. Benzodiazepines can be used as an additional treatment for mania. Adding a benzodiazepine such as clonazepam or lorazepam to acute attack treatment, provides a faster and more effective treatment. High dose parenteral use of benzodiazepines can lead to respiratory depression. As far as we know, no cases of Intensıve Care Unit follow-up requiring respiratory depression due to olanzapine or clonazepam use in an otherwise healthy than a psychiatric disorder is reported in the literature. We report a case of respiratory depression due to treatment of manic episode with olanzapine 10 mg pills and clonazepam 2 mg pills.

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1. Yıldız A, Alptekin K. Akut Ajitasyon Tedavisinde Doğrular ve Yanlışlar: Acil Servis Antiajitasyon Tedavi Rehberi. Klinik Psikofarmakoloji Bülteni 2003; 13:30-36.
2. Victor BS, Link NA, Binder RL, Bell IR. Use of clonazepam in mania and schizoaffective disorders. Am J Psychiatry 1984; 141:1111-1112.
3. Channing J, Hill S, Wetherill M, White O. Respiratory arrest and oversedation in an adolescent given intramuscular Clonazepam for rapid tranquillization. Ther Adv Psychopharmacol 2002; 2(Suppl.4):159-163.
4. Verma SD, Davidoff DA, Kambhampati KK. Management of the agitated elderly patient in the nursing home: the role of the atypical antipsychotics. J Clin Psychiatry 1998; 59(Suppl.19):50-55.
5. Tesar GE. The agitated patient, Part I: evaluation and behavioral management. Hosp Community Psychiatry 1993; 44(Suppl.4):329-331.
6. Aronson TA, Shukla S, Hirschovitz J. Clonazepam treatment of five lithium-refractory patients with bipolar disorder. Am J Psychiatry 1989; 146(Suppl.1):77-80.
7. Verimli A, Saygılı S, Kükürt R, Altınöz F, Türkcan A, Atalay H. Standart biyolojik tedavilerle kontrol altına alınamayan hospitalize psikiyatrik olgularda klonazepam. Psikofarmakolojide Yenilikler Sempozyumu, 1. Ulusal Sempozyum Kitabı, İstanbul, 1991, s.93-95.
8. Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmac Ther 1981; 30(Suppl.2):239-245.
9. Mouallem M, Wolf I. Olanzapine-induced respiratory failure. Am J Geriatr Psychiatry 2001; 9(Suppl.3):304-305.
10. Naso AR. Optimizing patient safety by preventing combined use of intramuscular olanzapine and parenteral benzodiazepines. Am J Health Syst Pharm 2008; 65(Suppl.12):1180-1183.
11. Zyprexa-pi.pdf [Internet]. Available at: http://pi.lilly.com/us/zyprexa-pi.pdf [kaynak 25 Mart 2017].
12. Shafer A. Complications of sedation with midazolam in the intensive care unit and a comparison with other sedative regimens. Crit Care Med 1998; 26(Suppl.5):947-956.
13. Barr J, Fraser GL, Puntillo K, Ely EW, Gélinas C, Dasta JF, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med 2013; 41(Suppl.1):263-306.
14. Coburn VA, Mycyk MB. Physical and chemical restraints. Emerg Med Clin North Am 2009; 27(Suppl.4):655-667.
15. Olkkola KT, Ahonen J. Midazolam and other benzodiazepines. Handb Exp Pharmacol 2008; (Suppl.182):335-60.
16. Berggren L, Eriksson I, Mollenholt P, Sunzel M. Changes in respiratory pattern after repeated doses of diazepam and midazolam in healthy subjects. Acta Anaesthesiol Scand 1987; 31(Suppl.8):667-672.
17. Sunzel M, Paalzow L, Berggren L, Eriksson I. Respiratory and cardiovascular effects in relation to plasma levels of midazolam and diazepam. Br J Clin Pharmacol 1988; 25(Suppl.5):561-569.
18. Wilson MP, Pepper D, Currier GW, Holloman GH, Feifel D. The psychopharmacology of agitation: consensus statement of the american association for emergency psychiatry project Beta psychopharmacology work group. West J Emerg Med 2012; 13(Suppl.1):26-34.
19. Zeller SL, Citrome L. Managing Agitation Associated with Schizophrenia and Bipolar Disorder in the Emergency Setting. West J Emerg Med 2016; 17(Suppl.2):165-172.
20. clonazepam.pdf [Internet]. Available at: https://www.accessdata.fda.gov/drugsatfda_docs /label/ 2013/017533s053,020813s009lbl.pdf [kaynak 25 Mart 2017]