Hypotensive effects of thioridazine in an elderly patient with traumatic brain injury

Neuroleptics have been used to help control agitation, restlessness, and hostility in patients with traumatic brain injury. However, there are many reported side-effects with the use of neuroleptics after brain injury, including memory and other cognitive impairments, as well as slowed neural recovery. Alpha-1 adrenergic blockade with resultant hypotensive and sedating effects has also been reported. This is a case report of a 70-year-old gentleman with traumatic brain injury and cardiovascular disease. Thioridazine was used to control severe behavioural problems but had to be discontinued secondary to marked hypotension. This case illustrates the need for awareness of the significant alpha-1 receptor interaction of some neuroleptics, especially in the elderly population with pre-existing heart disease.