Acute Psychosis Associated with Oral Trimethoprim-Sulfamethoxazole Therapy

Abstract

A 74 year old woman became progressively confused and developed visual hallucinations and delusions over a six day period, after the institution of routine oral trimethoprim-sulfamethoxazole therapy for a urinary tract infection. The medication was discontinued, and a marked improvement was noted 36 hours later. There was a complete return to normal mental functioning 60 hours after therapy was discontinued. The relationship between the patient's symptoms with the initiation and discontinuation of the medication suggests that the drug had a causal effect.

Trimethoprim/Sulfamethoxazole-Related Acute Psychosis in the Second Course of Treatment After a Stem Cell Transplant: Case Report and Literature Review

“…Undesired side effects of the central nervous system rarely have been identified, and only few case reports have been noted (Table 1). [2][3][4][5][6][7] Because the psychosis did not improve after discontinuation of the other medications, and it recovered only after we withdrew the TMP/SMX, we suggest that the TMP/SMX induced this complication. The pathomechanisms of TMP/SMX-related psychosis remain unclear, 7,8 and the characteristics of these cases vary in age, disease status, medication route, dosage, and time of onset.…”

“…1 The adverse effect of TMP/SMX therapy is uncommon and consists mainly of skin rash, while acute psychosis has been noted as a rare complication of the drug in case reports. [2][3][4][5][6][7] We describe a woman having an acute psychosis episode after undergoing an HSCT during her second course of TMP/SMX therapy at a higher dosage. The patient received a third, reduced-dosage TMP/SMX therapy, without psychosis 6 months later, which might favor a dose-related effect of this rare complication.…”

“…Our case agrees with the hypothesis that the psychotic reaction happened only with the second course, and with a higher dosage, and no adverse effects were found in other courses of treatment. However, the psychosis could occur in patients with a standard dosage of TMP/SMX, 4 or even a reduced dosage, 7 which raises the question that it is the individual that leads to this adverse effect. Therefore, drug and/or metabolite level monitoring should be performed to clarify things.…”

Neurologic Adverse Effects of Ranolazine in an Elderly Patient with Renal Impairment

“…In our patient, TMP‐SMX was initially implicated as the offending agent based on previous reports of TMP‐SMX–induced psychosis . However, the first administration of TMP‐SMX occurred after the onset of her neurologic symptoms.…”

Suspect novel adverse drug reactions to trimethoprim‐sulphonamide combinations in horses: A case series

“…Psychoses during therapy with TMP-sulphonamide combinations have manifested as visual hallucinations and extreme agitation. In no case was another cause for the clinical signs determined, despite extensive investigation (haematological and serum biochemical analysis, cerebrospinal fluid cytology, computed tomography and magnetic resonance imaging) and all patients recovered after withdrawal of medication (Mermel et al 1986;McCue and Zandt 1991;Gregor et al 1993;Salkind 2000;Saidinejad et al 2005;Weis et al 2006;Dakin 2009).…”