A Patient with Cancer Pain Developing Serotonin Syndrome and Concomitant Acute Dyskinesia Associated with Tramadol Hydrochloride

A 68-year-old man with a diagnosis of transformation to undifferentiated carcinoma of the left thyroid who was being treated with Lenvatinib presented with swelling and pain around the left clavicle, and tramadol was started. Two days later, he developed diarrhea, sweating, disorientation, and myoclonus, leading to a diagnosis of serotonin syndrome. He also exhibited dyskinesia including involuntary movements of the arms and legs and squirming movements of the trunk. Tramadol was thus discontinued. His myoclonus and dyskinesia resolved within half a day and had disappeared the day after tramadol discontinuation. These symptoms were attributed to tramadol because there was a reasonable temporal relationship between drug administration and the adverse event. Tramadol inhibits serotonin reuptake, and thus has the potential to cause serotonin syndrome. However, there have been relatively few reports describing the occurrence of this syndrome, and there have been none showing concomitant dyskinesia. Clinicians should be aware that tramadol can cause serotonin syndrome accompanied by dyskinesia.

<b>The Present Situation Regarding Kampo Medicine Use and Kampo Education in Three Hokkaido H</b><b>ospitals </b> / 日本東洋医学雑誌

<p>Medical therapies, adapted to local requirements, are necessary in the field of community medicine. Generalized medical treatment is often all there is in Japan's Konsen Area, due to the large number of elderly people and a paucity of medical institutions. Kampo medical treatment is useful for elderly patients with plural diseases, and the demand for such treatment has been increasing. Therefore, we collected data on Kampo prescriptions prescribed by the doctors at the Nakashibetsu Municipal Hospital, which is the main local hospital in the Konsen Area, from 2010 to 2013. We conducted similar investigations at the Kushiro Red Cross Hospital in Kushiro city, which is centrally located in the Konsen Area, and at Asahikawa Medical University Hospital in Asahikawa, central Hokkaido. The aim of these investigations was to compare Kampo medicine use based on hospital location and size. The results can be used in community medicine to enhance the use of Kampo medicine with increase for its demand. Medical students and doctors should be educated in Kampo medicines, since their prescriptions have a significant impact on community health.</p>