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Neurotoxic syndrome associated with risperidone and fluvoxamine
Roy R Reeves1, James E Mack, John J Beddingfield
1GV (Sonny) Montgomery Veterans Administration Medical Center, Department of Psychiatry, Jackson, MS 39216-5116, USA. roy.reeves2@med.va.gov
The Annals of Pharmacotherapy
|March 16, 2002
Summary
A patient developed a severe neurotoxic syndrome when treated with both risperidone and fluvoxamine. This case highlights the potential risks of combining antipsychotics with selective serotonin reuptake inhibitors.
Area of Science:
- Neuropharmacology
- Clinical Toxicology
- Psychiatry
Background:
- Concomitant use of antipsychotics and selective serotonin reuptake inhibitors (SSRIs) is common in psychiatric practice.
- Understanding potential drug interactions is crucial for patient safety.
Observation:
- A case report details a 24-year-old woman who developed a neurotoxic syndrome while on risperidone and fluvoxamine.
- Symptoms included confusion, diaphoresis, diarrhea, hyperreflexia, myoclonus, rigidity, and fever, necessitating intubation.
Findings:
- The patient's symptoms resolved after medication discontinuation and supportive care, including bromocriptine.
- The differential diagnosis between neuroleptic malignant syndrome (NMS) and serotonin syndrome (SS) was challenging due to overlapping symptoms.
- This suggests NMS and SS might be manifestations of a broader neurotoxic syndrome.
Implications:
- This case represents the first reported instance of neurotoxicity from the combination of risperidone and fluvoxamine.
- Clinicians must be vigilant for adverse reactions when prescribing antipsychotics with SSRIs.
- Further research into generalized neurotoxic syndromes is warranted.