Possible interaction between letrozole and long-acting injectable zuclopenthixol.

Mrs A, a 68-year-old woman with paranoid schizophrenia, was on long-term psychiatric treatment with long-acting intramuscular zuclopenthixol, quetiapine and alprazolam when, in April 2012, she was diagnosed with right breast infiltrating ductal carcinoma. After starting treatment with letrozole on 4 July, Mrs A progressively developed extrapyramidal symptoms and these were particularly evident after each zuclopenthixol administration. On 9 January, both quetiapine and alprazolam were stopped due to excessive lethargy. After the administration of the last dose of zuclopenthixol on 26 January, she presented with sedation, sialorrhea, festinant gait, axial dystonia and dysphagia, all of which were severe. The introduction of letrozole was the only change that had been made to her pharmacotherapeutic regimen in that period. The rest of the findings on neurological examination were normal. Renal function was adequate. Slow symptom onset and progressive worsening until full-blown clinical presentation after 6 months, and the dramatic improvement in the clinical picture achieved 2 days after treatment with biperiden, suggests a long-term insidious interaction leading to zuclopenthixol accumulation. To the best of our knowledge, this is the first report of a possible interaction between letrozole and zuclopenthixol. We consider that it warrants further investigation. In the meanwhile, physicians should be aware of the occurrence of this potentially serious drug-drug interaction.

The use of antipsychotics in a medium-long stay psychiatric hospital from 1998 to 2010.

OBJECTIVE: Atypical agents have emerged as the dominant choice among antipsychotics. Data about development of antipsychotic use in medium-long stay psychiatric hospitals is lacking. MATERIAL AND METHODS: Antipsychotic drug consumption data and cost was obtained from 1998 to 2010 for all inpatients of a 231-bed psychiatric hospital. Number of hospital stays was obtained from the hospital admission unit. Daily defined dose (DDD) values were those assigned by the WHO. Antipsychotic use was also measured using recently available consensus-based recommendations. Antipsychotic use was then calculated as the sum of individual DDD or total equivalent doses of all antipsychotics divided by the annual stay number. RESULTS: Antipsychotic use increased 135% from 1998 to 2010 when measured in DDDs or 108% when measured with the consensus-based recommendations. Antipsychotic expenditure has risen six-fold since 1998. This augmentation is due to the increase of use of atypical antipsychotics. CONCLUSION: In conclusion, antipsychotic use has at least doubled in the last 13 years. This growth, attributable to an increase in atypical drug use, has contributed to a six-fold increase in the total antipsychotic expenditure. Whether this prescription pattern has translated into palpable clinical benefits remains unclear.

Medication errors in Parkinson's disease inpatients in the Basque Country.

INTRODUCTION: Parkinson's disease (PD) medication errors, including both missing dopaminergic drug doses and antidopaminergic usage, have been suggested as risk factors for prolonged hospital stays. The objective of this study was to evaluate the prevalence of such errors in PD patients admitted to public acute-care hospitals in the Basque Country over a two year period and their association with clinically relevant adverse health outcomes, such as length of hospital stay and mortality. METHODS: All PD patients admitted to any of the 11 public acute-care hospitals in the Basque Country in 2011-2012 were included. Medication errors involved incorrect timing or the complete omission of administration for dopaminergic drugs, and the administration of centrally acting antidopaminergics. A logistic regression and a competing risk analysis were applied to verify whether those errors affected intrahospital mortality and length of stay. RESULTS: The study included 1628 patients admitted 2546 times. Medication errors, affecting almost one third of admissions and half of patients, were associated with higher mortality: inappropriately omitted dopaminergic drug doses OR = 1.92 CI 95% (1.34-2.76); inappropriate antiemetic administration OR = 2.15 CI 95% (1.36-3.39); and inappropriate antipsychotic administration OR = 1.91 CI 95% (1.33-1.73). Inappropriately omitted doses and both inappropriate antipsychotic and antiemetic administration were associated with a significant 4-day increase in median hospital stay. CONCLUSION: Medication errors (missing dopaminergic drug doses and centrally acting antidopaminergic use) are not only associated with increased length of hospital stays in PD patients, but also with a higher mortality rate.

Levofloxacin-Induced Delirium in a Patient Suffering from Schizoaffective Disorder and Multiple Sclerosis.

Levofloxacin induced psychiatric adverse effects are rare, although they can be serious. There are just five cases of fluoroquinolone-induced delirium published in the medical literature. To our best knowledge, none of them occurred in psychotic patients. We report a case of a 38-year-old Caucasian man diagnosed with schizoaffective disorder and multiple sclerosis who developed delirium and visual hallucinations after initiating levofloxacin therapy. In psychiatric patients, suspecting levofloxacin could be responsible for the symptoms can be a diagnostic challenge, since they could be interpreted like worsening of the mental state as well. Although levofloxacin-induced delirium is a rare adverse event, physicians should be aware of the occurrence of this serious, but potentially reversible CNS complication of levofloxacin, even in psychotic patients.