Sema BAYKARA, Gülay TAŞCI, Şüheda KAYA, Murad ATMACA, Sevda KORKMAZ

Klomipraminle gelişen lokal ödem

Klopiramin; noradrenalin ile serotonin (5HT) reuptake inhibisyonu yoluyla etki eden ve antikolinerjik etkilere de sahip trisiklik bir antidepresan ilaçtır. Periferik yapılarda kolinerjik reseptörleri bloke ederek atropin benzeri etki gösterir ve antikolinerjik etkilerine karşı zamanla tolerans gelişir. Baş dönmesi, uyuşukluk hali, baş ağrısı, sinirlilik, konstipasyon, iştah artışı, bulantı, ağız kuruluğu, karın ağrı- sı; libido değişiklikleri, terlemede artış hafif ortostatik hipotansiyon yapabilir ve kardiyovasküler sistemin homeostazı ile ilgili refleksleri deprese edebilir. Depresif bozukluk (DB) tanısı ile kliniğimizde yatarak tedavi gören hastanın klomipramin tedavisi sonrasında önce yüz bölgesinde ve ilerleyen günlerde sağ el ve ön kolunda lokal olarak gelişen bir ödemi vardı. Genel literatüre göre klomipraminin mast hücre stabilizasyonu ile ödem oluşumunu engelleyici etkisi vardır. Hayvan çalışmalarında ödem artırıcı etkisi gösterilmiş olsa da tedavi sırasında bu etkinliğine ait herhangi bir literatür bulgusu yoktur. Olgumuz bu açıdan ilk örnektir. Bu yazıda klomipramin tedavisi ile lokal ödem gelişen bir olgudan bahsedilecektir.

Edema induced with clomipramine

Clomipramine is a tricyclic antidepressant acting by reuptake inhibition at both norepinephrine (NE) and serotonin (5HT) transporters. Blocking muscarinic receptors in peripheral tissues, it shows atropine-like effects and tolerance develops overtime against the anticholinergic effects. It may produce dizziness, drowsiness, headache, irritability, constipation, increased appetite, nausea, dry mouth, stomachache, changes in libido, increased sweating, and mild orthostatic hypotension. It may also depress cardiovascular reflexes related to the homeostasis of the system. The patient with diagnosis of major depressive disorder (MDB) developed mild facial puffiness with periorbital edema. The following days he developed local edema including the right hand and right forearm. In previous studies, it was reported that clomipramine exerts an anti-inflammatory effect by mast cell-dependent mechanism and by inhibition of neutrophil migration. Although clomipramine was suggested to develop edema in animal experiments, it has not been shown during the treatments in previous studies. The case would be a new report. Here, we present a case of a patient who developed local edema during use of clomipramine.

PDF

___

Kayaalp SO. Antipsikotik İlaçlar. Rasyonel Tedavi Yönünden Tibbi Farmakoloji. Ankara: Feryal Matbaacılık; 1988:1847-83.
Settle EC Jr. Antidepressant drugs: disturbing and potentially dangerous adverse effects. J Clin Psychiatry. 1998;59(Suppl 16):25- 30.
Gurgel JA, Lima-Junior RC, Rabelo CO, Pessoa BB, Brito GA, Ribeiro RA. Amitriptyline, clomipramine, and maprotiline attenuate the inflammatory response by inhibiting neutrophil migration and mast cell degranulation. Rev Bras Psiquiatr. 2013;35:387-92.
Köroğlu E. Psikonozoloji Tanımlayıcı Klinik Psikiyatri. Ankara: HYB Yayıncılık; 2004.
Sundblad C, Hedberg MA, Eriksson E. Clomipramine administered during the luteal phase reduces the symptoms of premenstrual syndrome: a placebo-controlled trial. Neuropsychopharmacology. 1993;9:133-45.
Littrell JL. Taking the perspective that a depressive state reflects inflammation: implications for the use of antidepressants. Front Psychol. 2012;3:297.
Hilal-Dandan R, Brunton LL, Goodman LS. Goodman and Gilman's Manual of Pharmacology and Therapeutics. 2nd ed. New York: McGraw-Hill; 2014: 1206.
Vorobeychik Y, Gordin V, Mao J, Chen L. Combination therapy for neuropathic pain: a review of current evidence. CNS Drugs. 2011;25:1023-34.
Sacerdote P, Bianchi M, Panerai AE. Chlorimipramine and nortriptyline but not fluoxetine and fluvoxamine inhibit human polymorphonuclear cell chemotaxis in vitro. Gen Pharmacol. 1994;25:409-12.
Capuron L, Hauser P, Hinze-Selch D, Miller AH, Neveu PJ. Treatment of cytokine-induced depression. Brain Behav Immun. 2002;16:575-80.
Corcos M, Guilbaud O, Hjalmarsson L, Chambry J, Jeammet PH. Cytokines and depression: an analogic approach. Biomed Pharmacother. 2002;56:105-10.
Kulmatycki KM, Jamali F. Drug disease interactions: role of inflammatory mediators in depression and variability in antidepressant drug response. J Pharm Pharm Sci. 2006;9:292-306.
Vismari L, Alves GJ, Palermo-Neto J. Amitriptyline and acute inflammation: a study using intravital microscopy and the carrageenan-induced paw edema model. Pharmacology. 2010;86:231-9.
Bianchi M, Rossoni G, Sacerdote P, Panerai AE, Berti F. Effects of chlomipramine and fluoxetine on subcutaneous carrageenin- induced inflammation in the rat. Inflamm Res. 1995;44:466-9.
Abdel-Salam OM, Nofal SM, El-Shenawy SM. Evaluation of the anti-inflammatory and anti-nociceptive effects of different antidepressants in the rat. Pharmacol Res. 2003;48:157-65.
Hajhashemi V, Sadeghi H, Minaiyan M, Movahedian A, Talebi A. Central and peripheral anti-inflammatory effects of maprotiline on carrageenan-induced paw edema in rats. Inflamm Res. 2010;59:1053-59.
Sadeghi H, Hajhashemi V, Minaiyan M, Movahedian A, Talebi A. A study on the mechanisms involving the anti-inflammatory effect of amitriptyline in carrageenan-induced paw edema in rats. Eur J Pharmacol. 2011;667:396-401.
Clemons A, Vasiadi M, Kempuraj D, Kourelis T, Vandoros G, Theoharides TC. Amitriptyline and prochlorperazine inhibit proinflammatory mediator release from human mast cells: possible relevance to chronic fatigue syndrome. J Clin Psychopharmacol. 2011;31:385-7.
Ardid D, Eschalier A, Lavarenne J. Evidence for a central but not a peripheral analgesic effect of clomipramine in rats. Pain. 1991;45:95-100.