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2.
J Clin Neurosci ; 68: 33-38, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31400999

RESUMO

Intrathecal baclofen infusion trial is a sophisticated tool for selecting patients for permanent intra thecal baclofen infusion therapy We report our clinical experience of fifteen patients with refractory spasticity who underwent a continuous ITB trial using a temporary intraspinal indwelling catheter prior to permanent pump implantation. Patients underwent placement of a temporary intrathecal catheter that was connected to an external pump. Multisource feedback was obtained from the various healthcare professionals involved (Staff Nurse, Specialist nurse, physiotherapist, Doctor, family members, patient) regarding progress of test over 48-72 h. Average Modified Ashworth score after the trial was less than 2. Some degree of dose related minor adverse events (AEs) occurred in 8 patients, with the most common being nausea, constipation, urinary retention and hypotension. 10 patients received pump implant. 5 patients did not receive a pump because of AEs or because the goals were not met. 1 patient had pump removed after 4 years because of infection.


Assuntos
Baclofeno/administração & dosagem , Relaxantes Musculares Centrais/administração & dosagem , Espasticidade Muscular/tratamento farmacológico , Seleção de Pacientes , Idoso , Baclofeno/efeitos adversos , Cateteres de Demora , Feminino , Humanos , Bombas de Infusão Implantáveis , Injeções Espinhais , Masculino , Pessoa de Meia-Idade , Relaxantes Musculares Centrais/efeitos adversos , Estudos Retrospectivos
3.
Arch Phys Med Rehabil ; 100(5): 837-843, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31030729

RESUMO

OBJECTIVE: To report our experience using continuous intrathecal baclofen (ITB) administration prior to a possible ITB device implantation. DESIGN: Retrospective open label study. Mean duration of follow-up 64 months. SETTING: Primary-care and referral center, ambulatory and hospitalized care. PARTICIPANTS: Patients (N=116) undergoing continuous ITB trials between 2006 and 2017. INTERVENTIONS: Continuous application of baclofen via a temporary intrathecal catheter connected to an external pump. MAIN OUTCOME MEASURES: Assessment of the modified Ashworth Scale and range of movement prior versus end of ITB trial. According to the Barthel Index, definition of high-level patients (60-100 scoring points) and low-level patients (0-55 scoring points). Calculation of the Rivermead Mobility Index in high-level patients prior versus end of ITB trial. Evaluation of occurring adverse events. RESULTS: A total of 119 ITB trials were performed in 116 patients (78 men, mean age 41±16), 113 patients completed the trials (31 of 113 high level, 82 of 113 low level). The median modified Ashworth scale improved from 4 (interquartile range [IQR] 3-4) to 2 (IQR 1-2; P≤.001), the range of movement from 2 (IQR 1-3) to 3 (IQR 3-3; P≤.001). The Rivermead Mobility Index increased from 9 (IQR 6-12) to 10 (IQR 7-12.5; P=.004) in high-level patients. Eighty-eight out of 113 patients (78%) were appropriate candidates for ITB device surgery, 75 of 88 (85%) proceeded to an implantation. A total of 69 adverse events occurred in 57 of 119 trials (48%), 37 of 69 (54%) were drug related, 32 of 69 (46%) were procedure related, and 42 of 69 (61%) were minor. The ITB device was implanted in 69 of 75 patients (92%) at last follow-up. CONCLUSIONS: Continuous administration of ITB is an effective and useful alternative to ITB bolus application during ITB screening period. Half of the patients experienced adverse events; the majority were minor events.


Assuntos
Baclofeno/administração & dosagem , Bombas de Infusão Implantáveis , Relaxantes Musculares Centrais/administração & dosagem , Espasticidade Muscular/tratamento farmacológico , Adulto , Músculos do Dorso , Baclofeno/efeitos adversos , Feminino , Marcha , Humanos , Infusão Espinal , Masculino , Pessoa de Meia-Idade , Relaxantes Musculares Centrais/efeitos adversos , Seleção de Pacientes , Equilíbrio Postural , Estudos Retrospectivos
4.
Saudi J Kidney Dis Transpl ; 30(2): 513-516, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31031388

RESUMO

Thiocolchicoside (TCC) is a widely used centrally acting muscle relaxant. Epileptic seizures from the use of TCC are rarely reported. A 67-year-old male patient with endstage renal disease that was caused by hypertension was on maintenance hemodialysis (HD) for 22 months. He had taken TCC 8 mg capsules twice daily for four days due to painful myofascial spasm in neck and face muscles. At the end of the HD session, he had generalized tonic-clonic seizures. Epileptic seizures were brought under control with sodium valproate, and no recurrence of epileptic seizures was observed.


Assuntos
Colchicina/análogos & derivados , Falência Renal Crônica/terapia , Relaxantes Musculares Centrais/efeitos adversos , Convulsões/induzido quimicamente , Idoso , Colchicina/efeitos adversos , Humanos , Masculino , Diálise Renal
5.
Clin Obstet Gynecol ; 62(1): 37-47, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30614847

RESUMO

In this article, we describe a variety of medications that physicians managing outpatient chronic pain should familiarize themselves with to better aid their approach to multimodal pain therapy. Physicians should always consider the use of an adjuvant or coanalgesic drug as first-line treatments. Although many of these medications are not primarily analgesics, in clinical practice they have independent analgesic effects or synergistic analgesic properties when used with opioids. The use of adjunct analgesics reduces opioid-related adverse effects and optimizes pain management. Although there may be some medication overlap with this section and the ERAS section, the purpose of this article is to understand prolonged use in the outpatient setting to reduce opioid use or limit opioid dose with adjuvant therapy.


Assuntos
Analgésicos Opioides/efeitos adversos , Dor Crônica/tratamento farmacológico , Manejo da Dor/métodos , Acetaminofen/uso terapêutico , Analgésicos Opioides/administração & dosagem , Anestésicos Locais/administração & dosagem , Anestésicos Locais/efeitos adversos , Anti-Inflamatórios não Esteroides/administração & dosagem , Anti-Inflamatórios não Esteroides/efeitos adversos , Anticonvulsivantes/administração & dosagem , Anticonvulsivantes/efeitos adversos , Antidepressivos Tricíclicos/administração & dosagem , Antidepressivos Tricíclicos/efeitos adversos , Benzodiazepinas/administração & dosagem , Benzodiazepinas/efeitos adversos , Capsaicina/administração & dosagem , Capsaicina/efeitos adversos , Quimioterapia Adjuvante , Feminino , Humanos , Relaxantes Musculares Centrais/administração & dosagem , Relaxantes Musculares Centrais/efeitos adversos , Receptores de N-Metil-D-Aspartato/antagonistas & inibidores , Inibidores da Recaptação de Serotonina e Norepinefrina/administração & dosagem , Inibidores da Recaptação de Serotonina e Norepinefrina/efeitos adversos
6.
Clin Pharmacol Ther ; 105(3): 703-709, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30223305

RESUMO

Tizanidine, a widely used muscle relaxant that can lower blood pressure, is metabolized by the cytochrome P450 1A2 (CYP1A2). We studied 1,626 patients prescribed tizanidine and 5,012 prescribed cyclobenzaprine concurrently with a strong CYP1A2 inhibitor. The primary outcome was severe hypotension, defined as systolic blood pressure (SBP) ≤ 70 mmHg during periods of drug co-exposure. Severe hypotension occurred more often in the tizanidine group (2.03%; n = 33) than the cyclobenzaprine group (1.28%; n = 64); odds ratio (OR) = 1.60; P = 0.029. This difference remained statistically significant after adjustment for a log-transformed propensity score that included age, sex, race, Charlson's comorbidity index, and concurrent use of antihypertensive medications (OR = 1.57; P = 0.049). A sensitivity analysis that defined hypotension as SBP < 90 mmHg also yielded higher rates of hypotension among patients prescribed tizanidine. In conclusion, CYP1A2 inhibition increases the risk of hypotensive episodes associated with the use of tizanidine in routine clinical practice.


Assuntos
Clonidina/análogos & derivados , Inibidores do Citocromo P-450 CYP1A2/efeitos adversos , Citocromo P-450 CYP1A2/metabolismo , Hipotensão/induzido quimicamente , Hipotensão/metabolismo , Relaxantes Musculares Centrais/efeitos adversos , Adulto , Clonidina/administração & dosagem , Clonidina/efeitos adversos , Estudos de Coortes , Inibidores do Citocromo P-450 CYP1A2/administração & dosagem , Quimioterapia Combinada , Feminino , Humanos , Hipotensão/diagnóstico , Masculino , Pessoa de Meia-Idade , Relaxantes Musculares Centrais/administração & dosagem , Polimedicação , Estudos Retrospectivos , Fatores de Risco
7.
Eur J Gastroenterol Hepatol ; 31(4): 499-502, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30444744

RESUMO

BACKGROUND: Muscle cramps occur in 29-88% of patients with liver cirrhosis. They adversely affect quality of life. This study aimed to evaluate the efficacy and safety of methocarbamol as a novel therapy in controlling muscle cramps in cirrhotic patients. PATIENTS AND METHODS: This study was carried on 100 patients with liver cirrhosis in addition to chronic hepatitis C who presented with frequent muscle cramps (≥three cramps per week). Half of these patients received methocarbamol and the other half received placebo. This was done through equal randomization. Questionnaires on muscle cramp were answered. Patients were evaluated before, after 1 month of treatment, and 2 weeks after washout of treatment in terms of severity, duration, and frequency of cramps. Liver, renal functions, and electrolytes were analyzed. Also, any side effect was detected. RESULTS: Patients who were treated with methocarbamol showed a significant decrease in the frequency and duration of cramps. Also, the pain score improved significantly. However, no significant changes were observed in the placebo group. Few side effects of methocarbamol were recorded, including dry mouth and drowsiness. CONCLUSION: Methocarbamol seems to be a promising safe and well-tolerated medication, and plays a role in the treatment of muscle cramps in patients with liver cirrhosis.


Assuntos
Cirrose Hepática/complicações , Metocarbamol/uso terapêutico , Cãibra Muscular/tratamento farmacológico , Relaxantes Musculares Centrais/uso terapêutico , Adulto , Idoso , Método Duplo-Cego , Feminino , Hepatite C Crônica/complicações , Humanos , Cirrose Hepática/virologia , Masculino , Metocarbamol/efeitos adversos , Pessoa de Meia-Idade , Cãibra Muscular/etiologia , Relaxantes Musculares Centrais/efeitos adversos , Dor/prevenção & controle , Resultado do Tratamento
9.
Pediatrics ; 142(2)2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29976571

RESUMO

Intrathecal baclofen pumps are commonly used in pediatric patients with spastic cerebral palsy. Baclofen binds to γ-aminobutyric acid receptors to inhibit both monosynaptic and polysynaptic reflexes at the spinal cord level. The blockade stops the release of excitatory transmitters and thereby decreases muscle contraction. It is commonly used for lower limb spasticity and has been shown to improve postural ability and functional status. The US Food and Drug Administration has approved baclofen for the treatment of spasticity of cerebral or spinal origin in adult and pediatric patients 4 years or older. Various complications of baclofen pumps are described in the literature. Immediately after surgery, problems from infection can arise and range from superficial skin infections to meningitis and bacteremia. Another early complication includes cerebrospinal fluid leak that can be observed by notable swelling beneath the lumbar incision. Additional problems that arise later are usually from the mechanics of the pump and catheter. Pump-related complications include failure, migration, and flipping. Catheter-related complications include disconnection, occlusion, fracture, or kink. Most of these complications typically lead to baclofen withdrawal, although there are a few case reports of overdose due to mechanical causes. Here we describe 2 cases of individuals experiencing complications of excessive baclofen exposure after significant changes in the atmospheric pressure due to travel involving ambient altitude change. These cases reflect the need to discuss this potential complication with families and patients with baclofen pumps before travel to high elevations.


Assuntos
Altitude , Pressão Atmosférica , Baclofeno/efeitos adversos , Relaxantes Musculares Centrais/administração & dosagem , Sonolência , Pensamento/efeitos dos fármacos , Adolescente , Baclofeno/administração & dosagem , Feminino , Humanos , Injeções Espinhais , Masculino , Relaxantes Musculares Centrais/efeitos adversos , Pensamento/fisiologia
10.
Int J Clin Pharmacol Ther ; 56(10): 467-475, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29974857

RESUMO

Baclofen is a centrally-acting γ-amino butyric acid agonist used mainly in the symptomatic management of spasticity originating from the spinal cord. It is absorbed completely from the gastrointestinal tract, metabolized by the liver to a minor degree, and excreted unchanged by the kidneys. Baclofen is moderately lipophilic and can cross the blood-brain barrier easily. At the usual dosage, it acts mainly at the spinal level without central nervous system (CNS) side effects. During renal failure, however, the elimination of the drug will decrease with a prolonged half-life, resulting in a larger area-under-the-curve exposure and disproportionate CNS toxicity. Clinically, these patients with renal failure may present with a variety of toxic symptoms manifesting at therapeutic/sub-therapeutic doses of baclofen. In cases of unexplained mental status changes in a patient receiving baclofen therapy, a careful assessment of renal function and a high suspicion of baclofen-induced encephalopathy will be key to the diagnosis.
.


Assuntos
Baclofeno/efeitos adversos , Doenças do Sistema Nervoso Central/induzido quimicamente , Relaxantes Musculares Centrais/efeitos adversos , Insuficiência Renal/complicações , Baclofeno/administração & dosagem , Humanos , Relaxantes Musculares Centrais/administração & dosagem
11.
Spinal Cord ; 56(10): 996-999, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29895878

RESUMO

STUDY DESIGN: Retrospective chart audit. OBJECTIVE: To indicate the appropriate baclofen dosage to control severe spasticity of spinal origin and to develop the optimal administration protocol for long-term intrathecal baclofen (ITB) therapy. SETTING: Department of Orthopaedic Surgery, Spinal Injuries Center, Japan. METHODS: Thirty-four people with spasticity of various spinal origins who were consistently treated at our hospital were included. The median follow-up period was 6 years and 11 months. Measures of Ashworth score were taken before and after surgical implant of baclofen pump. We decided not to increase the baclofen dosage after the Ashworth score reached 1. We recorded the control of spasticity, changes in the baclofen dose, and the incidence of complications. RESULTS: The average Ashworth score was 3.31 (1.75-4.0) before implant surgery, 1.38 (1.0-2.25) after implant surgery, and 1.39 (1.0-2.25) at the final follow-up, while the average baclofen dose (therapeutic/optimal dose) was 230.6 µg/day (50-450). The incidence of each complication was as follows: 8.8% (n = 3) catheter-related, 2.9% (n = 1) pump-related and 5.9% (n = 2) drug tolerance. No patients experienced withdrawal syndrome. Dose fluctuation with changes in the pathology of the original disease was observed in three cases. CONCLUSIONS: The usage of the Ashworth score as a guide for dose adjustment was found to be a good objective indicator for ITB therapy. The administration based on this objective indicator made it possible to effectively manage patients with a relatively low dose of baclofen and a low rate of drug-related complications.


Assuntos
Baclofeno/administração & dosagem , Relaxantes Musculares Centrais/administração & dosagem , Espasticidade Muscular/tratamento farmacológico , Espasticidade Muscular/etiologia , Traumatismos da Medula Espinal/complicações , Baclofeno/efeitos adversos , Tolerância a Medicamentos , Seguimentos , Humanos , Bombas de Infusão Implantáveis , Injeções Espinhais , Relaxantes Musculares Centrais/efeitos adversos , Complicações Pós-Operatórias , Estudos Retrospectivos , Resultado do Tratamento
13.
Stud Health Technol Inform ; 247: 421-425, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29677995

RESUMO

Web forums are proposed as a new complementary source of knowledge to spontaneous reports by patients and healthcare professionals due to underreporting of adverse drug reactions (ADRs). Some authors suggest that signal detection could be a convenient method for gathering mentions of ADRs in patients' posts. Signal detection methods were proposed to mine pharmacovigilance databases, but little is known about their applicability to web forums. We describe a method implementing several traditional decision rules on signal detection with baclofen applied to a set of more than 6 million posts. We then cross-validated four unexpected signals applying a logistic regression method. Most adverse effects (AEs) described in the summary of product characteristics of baclofen were detected by signal detection methods. Some unexpected AEs were too. Therefore, web forums are confirmed as a complementary resource for improving current knowledge in pharmacovigilance by detecting unexpected adverse drug reactions.


Assuntos
Baclofeno/efeitos adversos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Relaxantes Musculares Centrais/efeitos adversos , Farmacovigilância , Sistemas de Notificação de Reações Adversas a Medicamentos , Bases de Dados Factuais , Pessoal de Saúde , Humanos
14.
J Neurosci Nurs ; 50(2): 116-119, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29521737

RESUMO

This article details an unreported potential cause of withdrawal symptoms in a patient with cerebral palsy who experienced intrathecal baclofen withdrawal shortly after placement of a baclofen pump with subsequent refill with Gablofen. Initial implantation of the baclofen pump with Lioresal occurred after a successful hospital trial of intrathecal injection via lumbar puncture. However, later, the patient did experience signs and symptoms of baclofen withdrawal after a pump refill was performed with Gablofen.


Assuntos
Baclofeno/efeitos adversos , Baclofeno/uso terapêutico , Paralisia Cerebral/tratamento farmacológico , Injeções Espinhais/efeitos adversos , Relaxantes Musculares Centrais/efeitos adversos , Relaxantes Musculares Centrais/uso terapêutico , Síndrome de Abstinência a Substâncias/complicações , Adulto , Feminino , Humanos , Espasticidade Muscular , Enfermagem em Neurociência
16.
J Spinal Cord Med ; 41(1): 102-105, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28406070

RESUMO

OBJECTIVE: To study the relationship between autonomic dysreflexia and intrathecal baclofen in patients with spinal cord injury. DESIGN: Retrospective chart review. SETTING: Inpatient and outpatient acute rehabilitation facility. PARTICIPANTS: Thirty-four subjects. INTERVENTIONS: We reviewed patients' medical records to ascertain the presence of symptomatic autonomic dysreflexia (AD) prior to and after implantation of an intrathecal baclofen (ITB) pump for spasticity in spinal cord injury patients. We recorded risk factors for autonomic dysreflexia including kidney and bladder stones, heterotopic ossification (HO), and ischial / sacral pressure ulcers. OUTCOME MEASURES: Presence of autonomic dysreflexia pre and post-intrathecal baclofen pump placement, presence of risk factors associated with autonomic dysreflexia including (1) kidney or bladder stones, (2) heterotopic ossification, and (3) pressure ulcers. RESULTS: Of the 34 subjects, 25 (73.5%) experienced AD prior to ITB pump placement and only 2 (5.9%) after placement. Four subjects (11.8%) had kidney or bladder stones, of which, all had AD prior to placement and none had AD afterwards. Twenty-six subjects (76.5%) had pressure ulcers, of which, all experienced AD prior to placement and only one (0.02%) afterwards. Six patients (17.6%) had HO, of which 5 (83%) had AD prior to placement and none afterwards. Additionally, three patients (8.8%) had at least 2 of the above risk factors, of which, all had AD prior to ITB placement and none afterwards. CONCLUSION: This study showed a significant reduction of symptomatic episodes of autonomic dysreflexia after spinal cord injury, even in those with additional risk factors for development of autonomic dysreflexia.


Assuntos
Disreflexia Autonômica/etiologia , Baclofeno/efeitos adversos , Relaxantes Musculares Centrais/efeitos adversos , Traumatismos da Medula Espinal/tratamento farmacológico , Cálculos Urinários/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Disreflexia Autonômica/epidemiologia , Baclofeno/administração & dosagem , Baclofeno/uso terapêutico , Feminino , Humanos , Infusão Espinal/efeitos adversos , Masculino , Pessoa de Meia-Idade , Relaxantes Musculares Centrais/administração & dosagem , Relaxantes Musculares Centrais/uso terapêutico
18.
Pediatr Emerg Care ; 34(5): e85-e86, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-28441246

RESUMO

Intrathecal baclofen therapy has become increasingly popular because of its effectiveness in treating spasticity in pediatric patients. The device implanted into each patient is structurally similar. However, x-ray imaging can give the appearance of missing or extraneous objects on or near the intrathecal baclofen device. The composition of the material used in making the catheters is transparent on x-ray images. In addition, the connection port between the pump and catheter may resemble the shape of a needle. This has led to confusion among emergency room personnel, and unnecessary panic for other people involved. It is important that medical professionals understand many of the new designs of the pump-connector system to avoid further complications.


Assuntos
Baclofeno/administração & dosagem , Bombas de Infusão Implantáveis/efeitos adversos , Injeções Espinhais/instrumentação , Relaxantes Musculares Centrais/administração & dosagem , Medula Espinal/diagnóstico por imagem , Baclofeno/efeitos adversos , Cateteres de Demora , Diagnóstico Diferencial , Desenho de Equipamento/efeitos adversos , Desenho de Equipamento/métodos , Falha de Equipamento , Humanos , Injeções Espinhais/efeitos adversos , Relaxantes Musculares Centrais/efeitos adversos , Medicina de Emergência Pediátrica/métodos
19.
Am J Kidney Dis ; 71(2): 275-280, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-28899601

RESUMO

Baclofen, a commonly prescribed muscle relaxant, is primarily excreted via the kidneys; toxicity is a potentially serious adverse outcome in patients with decreased kidney function. We describe a patient with end-stage kidney disease receiving hemodialysis who developed neurotoxicity and hemodynamic instability after receiving baclofen for muscle spasms. In this case, prompt recognition of baclofen toxicity and urgent hemodialysis were effective in reversing this toxicity. This case is used to examine the pharmacokinetics and pathophysiology of baclofen toxicity and discuss appropriate diagnosis and management of baclofen toxicity. We recommend reducing the baclofen dose in patients who have moderately reduced kidney function (estimated glomerular filtration rate, 30-60mL/min/1.73m2) and avoiding use in patients with severely reduced kidney function (estimated glomerular filtration rate < 30mL/min/1.73m2) or on renal replacement therapy.


Assuntos
Baclofeno , Falência Renal Crônica , Síndromes Neurotóxicas , Diálise Renal/métodos , Eliminação Renal , Espasmo , Baclofeno/administração & dosagem , Baclofeno/efeitos adversos , Baclofeno/farmacocinética , Relação Dose-Resposta a Droga , Hemodinâmica/efeitos dos fármacos , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/terapia , Testes de Função Renal/métodos , Masculino , Pessoa de Meia-Idade , Relaxantes Musculares Centrais/administração & dosagem , Relaxantes Musculares Centrais/efeitos adversos , Relaxantes Musculares Centrais/farmacocinética , Síndromes Neurotóxicas/diagnóstico , Síndromes Neurotóxicas/etiologia , Síndromes Neurotóxicas/terapia , Espasmo/complicações , Espasmo/tratamento farmacológico , Resultado do Tratamento , Suspensão de Tratamento
20.
Psychopharmacol Bull ; 48(4): 15-19, 2018 06 20.
Artigo em Inglês | MEDLINE | ID: mdl-30618472

RESUMO

Due to the stringent regulatory environment for therapeutics, common side-effects of drugs in the general population are largely well-documented. This is however less the case with certain patient subgroups who may exhibit significant adverse responses to therapeutics that are otherwise well-tolerated. We report a case of psychosis induced by exposure to a commonly prescribed drug to treat muscle spasms and associated pain cyclobenzaprine (Flexeril®). Cyclobenzaprine is structurally very similar to tricyclic anti-depressants, such as amyltriptine. While it is well known that agitation caused by cyclobenzaprine is not an uncommon occurrence in the elderly, there have also been sporadic reports of significant psychosis in association with the use of cyclobenzaprine in younger patients. We report a case of reversible mania in a susceptible 44-year-old patient with a lengthy history of mild borderline personality and bipolar disorder. Shortly after being treated with cyclobenzaprine for pain due to a minor injury, this patient exhibited significant signs of mania although these signs were readily reversible upon termination of the treatment with cyclobenzaprine. The patient's severe adverse reaction to this normally innocuous drug adds weight to the notion that there is reason for caution with its prescription for potentially susceptible patient subgroups.


Assuntos
Amitriptilina/análogos & derivados , Antidepressivos Tricíclicos/efeitos adversos , Transtorno Bipolar/tratamento farmacológico , Transtorno da Personalidade Borderline/tratamento farmacológico , Relaxantes Musculares Centrais/efeitos adversos , Psicoses Induzidas por Substâncias/etiologia , Tranquilizantes/uso terapêutico , Adulto , Amitriptilina/efeitos adversos , Feminino , Humanos
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