Neurolepic malignant syndrome induced by duloxetine
10.3760/cma.j.cn114015-20220417-00327
- VernacularTitle:度洛西汀致神经阻滞剂恶性综合征
- Author:
Changkai ZHOU
1
;
Wenjing LI
1
;
Xiaojia HAO
1
;
Donghua LIU
1
;
Hongyan JI
1
;
Xiaomin XING
1
;
Jing LI
1
Author Information
1. 青岛大学附属医院药学部，青岛 266000
- Publication Type:Journal Article
- Keywords:
Duloxetine;
Neuroleptic malignant syndrome;
Depression
- From:
Adverse Drug Reactions Journal
2023;25(3):183-185
- CountryChina
- Language:Chinese
-
Abstract:
A 69-year-old male patient with depression was treated with amfebutamone and mirtazapine for a long time. Because of poor control of symptoms, the treatment plan was adjusted to oral duloxetine (60 mg in the morning) and mirtazapine (15 mg at night). After 13 days of treatments, the patient developed high fever (41.0 ℃) with disturbance of consciousness, followed by muscle rigidity and dyspnea. His heart rate was 180 beats/min and blood oxygen saturation was 0.84. Laboratory tests showed serum creatinine (Scr) 609 μmol/L, creatine kinase (CK) 7 102 U/L, myoglobin (MYO) >3 000 μg/L, aspartate aminotransferase (AST) 88 U/L, and total bilirubin (TBil) 33.7 μmol/L. ECG monitoring showed rapid atrial fibrillation. The patient was diagnosed with malignant syndrome caused by duloxetine after excluding infection and other conditions. Duloxetine and mirtazapine were stopped immediately, and symptomatic and supportive treatments including endotracheal intubation, hemofiltration, improvement of water-electrolyte balance, and hepatoprotection were given. On the 6th day of drug withdrawal, the patient′s temperature was 38.2 ℃, the blood oxygen saturation was 0.96, muscle tone was improved, and muscle tremor disappeared. On the 16th day of drug withdrawal, the patient′s condition was obviously improved, the consciousness was clear, the temperature was normal, the call could be answered, and no limb convulsion and muscle tremor occurred. Laboratory tests showed Scr 116 μmol/L, CK 250 U/L, MYO 148 μg/L, AST 38 U/L, and TBil 21.4 μmol/L.
