Antidepresan Tedaviye Risperidon Eklenmesi ile İlişkili Anjiyoödem: Olgu Sunumu

Anjiyoödem, derin cilt ve cilt alty dokularyn ödemidir.Ylaçlara ba?ly anjiyoödemin mekanizmasy tam olarak bilinmemektedir. Pro-enflamatuar modülatörlerin, özellikleimmünglobülin E (IgE) ile ili?kili tip 1 hipersensitivitereaksiyonunun anjiyoödeme yol açty?y dü?ünülmektedir.Ylaca ba?ly anjiyoödem, ürtiker e?lik eden ya da etmeyen,alerjik/ non-allerjik ?eklinde synyflandyrylabilmektedir.Alerjik anjiyoödem immünglobülin-E ile ili?kilidir. Nonalerjik anjiyoödem, herediter, kazanylmy?, renin-anjiyotensin-aldosteron sistemi (RAAS) blokörleriyle ili?kili,psödoallerjik veya idyopatik olabilir. Literatürde, venlafaksin, mirtazapin ve risperidonun tek ba?yna ya da birlikte kullanymy ile ili?kili anjiyoödem olgulary bildirilmi?tir.Olgumuz, 41 ya?ynda, evli, kadyn hasta psikiyatri poliklini?ine depresyon yakynmalary ile ba?vurdu. Hasta 2 aydyrfluoksetin 20 mg /gün ve mirtazapin 30 mg /gün kullanmaktaydy. Almakta oldu?u fluoksetinin etkisiz oldu?udü?ünülerek fluoksetin kesildi, mirtazapine ek olarakvenlafaksin 75 mg /gün ve ajitasyonuna yönelik olarakrisperidon 0.5 mg /gün ba?landy. Hastada anjiyoödemgeli?mesi üzerine risperidon kesildi. Risperidonunkesilmesinin ardyndan hastanyn anjiyoödem yakynmalarynda gerileme oldu. Anjiyoödemin antidepresantedaviye risperidon eklenmesi ile ili?kili oldu?udü?ünüldü. Hipotansiyon gibi sistemik bir bulgununolmamasy, normal serum IgE düzeyi ve anjiyoödemeürtikerin e?lik etmemesi, non-allerjik anjiyoödemidü?ündürdü. Anjiyoödem psikotrop ilaçlaryn yan etkisiolarak hekimlerin kar?ysyna çykabilmekte ve bazen ya?amytehdit eden sonuçlara yol açabilmektedir. Bundan dolayyalerjik reaksiyon öyküsü olan hastalarda özellikle birdenfazla ilaç kullanylacaksa çok dikkatli olunmasy gerekmektedir.

Angioedema Associated with Addition of Risperidone to Antidepressant Treatment: A Case Report

Angioedema is an edema of the skin and subcutaneoustissues. The exact mechanism of medication inducedangioedema is not known well. Pro-inflammatory modulators, especially IgE-related type-1 hypersensitivity reactions are thought to cause angioedema. Medicationinduced angioedema can be classified as angioedemawith / without urticaria or allergic / non-allergicangioedema. Allergic angioedema is related withimmunglobulin E. Non-allergic angioedema can be seenas hereditary, acquired, renin-angiotensin-aldosteronsystem (RAAS) blockers related, pseudoallergic or idopathic. Cases of angioedema induced by venlafaxine,mirtazapine and risperidon were reported in the literature. In our case, a 41 years old, married female patientwith depressive symptoms was brought to psychiatryoutpatient unit. The patient had been on 20 mg/day fluoxetine and 30 mg/day mirtazapine for 2 months.Fluoxetine had been stopped for it was thought to beineffective. Venlafaxine 75 mg/day was added to mirtazapine as combination treatment and risperidone wasgiven 0.5 mg /day for agitation. We stopped risperidoneimmediately after the occurrence of angioedeme andangioedema disappeared consequently. Angioedemawas thougth to be related with addition of risperidoneto antidepressant treatment. Angioedema was notshown to be associated with any systemic signs such ashypotension, serum IgE level was normal and nourticaria was detected at the time of angioedema. As aresult it was considered to be a non-allergic angioedema. Clinicians may encounter with angioedema due topsychotropic drugs and it may have fatal results. Due tothese findings clinicians should prescribe multiple medications with caution, especially in cases with history ofallergy.

Kaynakça

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