Süleyman DEMİR, Abdullah ATLI, MEHMET GÜNEŞ, Songül ÇATI, EŞREF AKIL, Nuralay ÇETİNKAYA

Tek doz bupropion kullanımına bağlı akut distoni: Bir olgu sunumu

Bupropiyon SR, sigara bırakma tedavisi için Food and Drug Administration ve Avrupa Birliğinde onay alm ış nikotin dışı önemli bir farmakolojik seçenektir. Ayrıca majör depresyon tedavisinde kullanılan bupropiyon, noradrenalin ve dopamin geri alım inhibitörü olarak etki gösteren ajanlardan biridir. Tütün bağımlılığında dopamin ödüllendirme yolağını bloke ederek ve noradrenalin yolağına bağlı olarak ortaya çıkan yoksunluk belirtilerini azaltarak etki ettiği düşünülmektedir. Biz burada ilk doz bupropion SR aldıktan sonra akut distoni gelişen bir majör depresyon ve komorbid nikotin bağımlılığı olgusunu sunmayı amaçladık. Otuz iki yaşındaki erkek hastaya majör depresyon ve komorbid nikotin bağımlılığı tanısı konuldu. Hastada ek psikiyatrik ve psikiyatri dışı bir hastalık yoktu. Kullandığı herhangi bir ilaç yoktu. Hastaya bupropiyon 300 mg/gün başlandı. Hasta aldığı ilk doz 300 mg bupropiondan sonra boynunda kasılma hissi, dilini sürekli ağız dışında tutma ve tükürüğünü yutamama yakınmalarıyla acil servise başvurdu. Rutin laboratuvar testleri normal bulundu ve nörolojik muayenede akut distoni dışında bir patolojik bulgu saptanmadı. Klinik tablo bupropiyona bağlı akut distoni olarak değerlendirildi. Hastaya 5 mg biperiden i.m. yapıldı ve belirtiler düzeldi. Hastanın 24 saat sonraki muayenesinde distoni belirtileri yoktu. Bupropiyon kullanım ında görü- len yan etkiler uykusuzluk, baş ağrısı ve ağız kuruluğu, döküntü, bulantı, uykusuzluk, aşırı terleme, kulak çınlaması, hipertansiyon şeklinde sıralanabilir. Bupropiyonla ilişkili olarak literatürde hipomani, akut psikoz, görsel halüsinayon gibi psikiyatrik tablolarla beraber distoni, hiponatremi, hipokalemi, trombotik trombositopenik purpura gibi bazı farklı psikiyatri dışı genel tıbbi tablolar bildirilmiştir.

Single dose bupropion related acute dystonia: a case report

Bupropion is an important pharmacologic agent similar to nicotine in the treatment of smoking cessation approved by Food and Drug Administration and European Union. Also, bupropion is an agent in the treatment of major depression as noradrenaline and dopamine reuptake inhibitor. In nicotine addiction, it is thought that it affects by blocking the dopamine reward pathway and decreasing the withdrawal symptoms related with noradrenaline path- way. We aimed to present a case with major depression and nicotine addiction developing acute dystonia with use of bupropion. Thirty-two year-old male, was diagnosed as having major depression and comorbid nicotine addiction. He did not have either another psychiatric problems or another medical disease and also he had not been using any kind of medicine. He was started to have 300 mg/day bupropion. The day after having first dose of 300 mg bupropion, he had some kind of pseudoesthesias which caused sense of his neck being shorten, holding his tongue out of his mouth, and not swallowing his saliva so he was taken to emergency. Evaluations and routine testing were observed normal ranges and there were not determined any pathologic issues out of acute dystonia during the neurologic examination. Clinical table showed that acute dystonia related to bupropion. His symptoms were getting better after he was given 5 mg biperiden as i.m. Finally, it was observed that there were not any dystonia symp- toms after 24 hours of his check. Side effects of bupropion include insomnia, headache, dry mouth, eruption, nausea, excessive sweating, tinnitus and hypertension. Psychiatric problems including hypomania, acute psychosis, visual hallucinations and dystonia, hyponatremia, hypokalemia, and thrombotic thrombocytopenic purpura also reported as side effects of bupropion use in literature.

PDF

___

1. Glynn DA, Cryan JF, Kent P, Flynn RA, Kennedy MP. Update on smoking cessation therapies. Adv Ther 2009; 26:369-382.
2. Benowitz NL. Pharmacology of nicotine: addiction, smoking-induced disease, and therapeutics. Annu Rev Pharmacol Toxicol 2009; 49:57-71.
3. Richmond R, Zwar N. Review of bupropion for smolcing cessation. Drug Alcohol Rev 2003; 22(2):203-220.
4. Dwoskin LP, Rauhut AS, King-Pospisil KA, Bardo MT. Review of the pharmacology and clinical pro- file of Bupropion, an antidepressant and tobacco use cessation agent. CNS Drug Rev 2006; 12(3- 4):178-207.
5. Aggarwal A, Sharma RC. Bupropion-induced mania and hypomania:A report of two cases. J Neuropsychiatry Clin Neurosci 2011; 23(2):51-52.
6. Golden RN, James SP, Sherer MA, Rudorfer MV, Sack DA, Potter WZ. Psychoses associated with bupropion treatment. Am J Psychiatry 1985; 142:1459-1462.
7. Cheng WC, Liu CM, Hsieh MH, Hwang TJ. Bupropion-related parkinsonism and dystonia. J Clin Psychopharmacol. 2009 Dec;29(6):616-618.
8. Detweiler MB, Harpold GJ. Bupropion-induced acute dystonia. Ann Pharmacother 2002;36:251- 254.
9. Wang HY, Chou WJ, Huang TY, Hung CF. Acute dystonia resulting from abrupt bupropion discontinuation. Prog NeuroPsychopharmacol Biol Psychiatry 2007; 31:766-768.
10. Bateman DN, Rawlins MD, Simpson JM. Extra- pyramidal reactions with metoclopramide. BMJ 1985; 291:930-932.
11. Rupniak NM, Jenner P, Marsden CD. Acute dystonia induced by neuroleptic drugs. Psychopharmacology (Berl) 1986; 88:403-419.
12. Bateman DN, Darling WM, Boys R, Rawlins MD. Extrapyramidal reactions to metoclopramide and prochloperazine. Q J Med 1989; 71:307-311.
13. Song X, Hu Z, Zhang H. Acute dystonia induced by lamivudine. Clin Neuropharmacol 2005; 28:193- 194.
14. Taycan SE, Demir S, Celikel FC. The relationship of selective serotonin reuptake inhibitors with Parkinsons disease and parkinsonism: two case reports. Anatolian Journal of Psychiatry 2011; 12:315-317.
15. Golden RN. Diethylpropion, bupropion, and psychoses. Br J Psychiatry 1988; 153:265-266.
16. Meyer JH, Goulding VS, Wilson AA, Hussey D, Christensen BK, Houle S. Bupropion occupancy of the dopamine transporter is low during clinical treatment. Psychopharmacology (Berl) 2002; 163:102-105.
17. El Mansari M, Ghanbari R, Janssen S, Blier P. Sustained administration of bupropion alters the neuronal activity of serotonin, norepinephrine but not dopamine neurons in the rat brain. Neuropharmacology 2008; 55:1191-1198.
18. Foley KF, DeSanty KP, Kast RE. Bupropion. Pharmacology and therapeutic applications. Expert Rev Neurotherapeutics 2006; 6:1249-1265.
19 Arnone D, Hansen L, Kerr JS. Acute dystonic reaction in an elderly patient with mood disorder after titration of paroxetine: possible mechanisms and implications for clinical care. Psychopharmacol 2002; 16:395-397.