Beta-agonist inhaler causing hallucinations

Schnapf, Bruce M.; Santeiro, Maria L.

doi:10.1097/00006565-199404000-00006

Cited by 8 publications

(6 citation statements)

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“…The dose-dependent β-agonist-related adverse effects include headache, dizziness, nervousness, mild tachycardia, palpitations, hypokalemia, hyperglycemia, nausea, muscle tremors, tenseness, and peripheral vasodilation [2,8,9]. Excessive ingestions can lead to hallucinations, severe headaches, convulsions, nausea, and vomiting [17,18].…”

Section: Discussionmentioning

confidence: 99%

Acute clenbuterol overdose resulting in supraventricular tachycardia and atrial fibrillation

et al. 2007

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Objective: We are presenting a case illustrating the complex metabolic and rhythm disturbances associated with acute clenbuterol intoxication.Background: Clenbuterol is a long-acting β 2 -adrenergic agonist primarily used in veterinary medicine in the United States. It has become a common drug of abuse by body builders because of its reported anabolic and lipolytic properties. In this case report, a body builder using veterinary clenbuterol developed significant electrolyte and cardiac manifestations.Case Report: A 31-year-old man presented to the emergency department approximately 30 minutes after ingesting 1.5 ml (a tenfold dosing error) of Ventipulmin ® syrup (72.5 mcg/ml clenbuterol HCl). The product was brought to the emergency department (ED) by the patient. He reported no current use of anabolic steroids. He presented in an anxious state with complaints of palpitations and shortness of breath. Vital signs upon examination were as follows: BP, 122/77 mmHg (16.3/10.3 kPa); HR 254 bpm; RR, 22 bpm; Temperature, 97.1°F (36°C); and oxygen saturation, 100% on ambient air. His electrocardiogram (ECG) demonstrated supraventricular tachycardia with a ventricular rate of 254 bpm. Esmolol was recommended for rate control after the unsuccessful use of adenosine and diltiazem. Laboratory studies showed potassium, 2.1 mmol/L; magnesium, 1.3 mg/dL (0.54 mmol/L); phosphorus, 1.0 mg/dL (0.32 mmol/L); serum glucose, 209 mg/dL (11.6 mmol/L); creatinine, 0.8 mg/dL (70.7 µmol/L); AST, 20 U/L; ALT, 55 U/L; hemoglobin, 12.6 g/dL (126 g/L); CPK total, 87 U/L; and troponin I, 0.23 µg/L. The patient's urine was negative for any drugs of abuse. Clenbuterol levels were not obtained. A second ECG, 16 hours post ingestion, reflected atrial fibrillation with a ventricular rate of 125 to 147 bpm. On hospital day 3, he was electively cardioverted to sinus rhythm; heart rate and rhythm returned to normal, and he was discharged with oral metoprolol.Discussion: Clenbuterol is approved for use in countries outside the U.S. as a bronchodilator for the treatment of acute asthma exacerbations in humans. Although clenbuterol is not a steroid hormone, it possesses anabolic properties that increase muscle mass. Its longer duration of action compared to other β 2 -agonists (such as albuterol) make it a desired agent for body-building because of its high and prolonged serum level. The mechanism for the short and long-term cardiovascular complications of clenbuterol is complex. The anabolic effects of clenbuterol are associated with its β 2 -adrenoreceptor agonist activity on striated skeletal muscles. In addition, clenbuterol promotes lipolysis through adipocyte β 3 -adrenoreceptors.Conclusion: Considering the significant number of body-building enthusiasts, physicians will continue to encounter clenbuterol abuse in their clinical practices.

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Section: Discussionmentioning

confidence: 99%

Acute clenbuterol overdose resulting in supraventricular tachycardia and atrial fibrillation

et al. 2007

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“…Hallucinations or psychoses can occur with abuse of an albuterol inhaler. 9 In our patient, medication use was strictly monitored by the mother, and there was no use of albuterol, nor overuse of formoterol. Asthma, independent of medication, increases risks of psychological disturbances.…”

Section: Discussionmentioning

confidence: 73%

“…Altered mood and/or thought disorders can occur with acute and habitual overuse of asthma medication. Hallucinations or psychoses can occur with abuse of an albuterol inhaler 9. In our patient, medication use was strictly monitored by the mother, and there was no use of albuterol, nor overuse of formoterol.…”

Section: Discussionmentioning

confidence: 73%

Suicidal ideation and thought disorder associated with the formoterol component of combined asthma medication

Rosario

Bender

White

2012

Pediatric Pulmonology

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Combination inhaled asthma medications containing corticosteroids and long-acting beta-adrenergic (LABA) agents are generally well tolerated, although a small minority of children receiving them may develop side-effects. Herein is reported a case of a 9-year-old boy who developed insomnia, pressured speech, agitation, and suicidal ideation within the 1st month after initiating formoterol + budesonide. He had not received oral glucocorticoids for >90 days. All symptoms resolved within 48 hr upon discontinuing formoterol while continuing budesonide. To our knowledge, this is the first report of childhood suicidal ideation strongly associated with use of a combination inhaled corticosteroid/LABA.

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“…7 Although its contribution cannot be ruled out, it is unlikely that the LABA component of the inhaled medication contributed to the described adverse reaction, as these symptoms have not been previously reported in the literature beyond the inappropriate use of LABA inhalers due to the abuse of the chlorofluorocarbons (CFCs) propellant. 8 Moreover, the anticholinergic properties of tiotropium may have been a contributing factor for the emergence of delirium, but the patient was not actively using tiotropium during the rechallenge and subsequent reemergence of delirium. Thus, tiotropium also seems to be an unlikely contributor.…”

Section: Discussionmentioning

confidence: 99%

Combination of Inhaled Corticosteroid and Bronchodilator-Induced Delirium in an Elderly Patient With Lung Disease

Moss

Kemp²,

Brown³

2013

Journal of Pharmacy Practice

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Steroid psychosis has been well described with oral glucocorticoids, however, our search of the literature did not identify an association between delirium and the combination of inhaled glucocorticoids and long-acting beta-agonists. We describe the occurrence of delirium with the combination of an inhaled glucocorticoid and bronchodilator. An elderly male described confusion and hallucinations within 1 week after initiation of budesonide/formoterol for chronic obstructive pulmonary disease. The combination inhaler was discontinued with resolution of symptoms. Several weeks later, the patient was hospitalized and restarted on the combination inhaler. The patient was alert and oriented on admission, however, confusion and hallucinations progressed throughout his hospital stay. The combination inhaler was discontinued and his confusion and hallucinations resolved by discharge. The temporal relationship of these events and a probable Naranjo association allows for reasonable assumption that the use of the budesonide/formoterol combination inhaler caused or contributed to the occurrences of delirium in this elderly patient. The onset of delirium was likely due to the systemic absorption of the glucocorticoid from lung deposition, complicated in an individual with several predisposing risk factors for delirium. Health care providers should be aware of this potential adverse drug reaction when prescribing inhaled medications to older patients at risk for delirium.

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Beta-agonist inhaler causing hallucinations

Cited by 8 publications

References 0 publications

Acute clenbuterol overdose resulting in supraventricular tachycardia and atrial fibrillation

Acute clenbuterol overdose resulting in supraventricular tachycardia and atrial fibrillation

Suicidal ideation and thought disorder associated with the formoterol component of combined asthma medication

Combination of Inhaled Corticosteroid and Bronchodilator-Induced Delirium in an Elderly Patient With Lung Disease

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