Carisoprodol Withdrawal Syndrome

Reeves, Roy R.; Beddingfield, John J; Mack, James E.

doi:10.1592/phco.24.17.1804.52333

Cited by 25 publications

(16 citation statements)

References 15 publications

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“…Some patients also demonstrate hallucinations and other psychotic symptoms. Recently, withdrawal from carisoprodol, which is metabolized to meprobamate, was reported with similar symptoms (2). Described here is a patient with carisoprodol withdrawal misdiagnosed as a psychotic disorder.…”

mentioning

confidence: 83%

“…Almost 20% of individuals with meprobamate withdrawal experience hallucinations or other psychotic symptoms (1), and the previous report of carisoprodol withdrawal involved a patient with vivid hallucinations and bizarre behavior (2). Carisoprodol/meprobamate withdrawal should be considered in the differential diagnosis of acute psychosis of uncertain etiology.…”

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confidence: 99%

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Carisoprodol Withdrawal Syndrome Misdiagnosed as a Psychotic Disorder

Reeves¹,

Ladner²

2008

Annals of Clinical Psychiatry

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Typical meprobamate withdrawal symptoms may include anxiety, insomnia, vomiting, tremors, muscle twitching, and ataxia (1). Some patients also demonstrate hallucinations and other psychotic symptoms. Recently, withdrawal from carisoprodol, which is metabolized to meprobamate, was reported with similar symptoms (2). Described here is a patient with carisoprodol withdrawal misdiagnosed as a psychotic disorder.A 25-year-old male with no history of mental illness or medical problems was hospitalized after acutely developing auditory and visual hallucinations and paranoia. Two days prior he was reported to have been having no problems. To examination he was tremulous, suspicious, easily agitated, and responding to internal stimuli. He admitted seeing small animals and flashes of brightly colored light and hearing multiple voices. Physical examination was unremarkable. Laboratory studies were within normal limits, and urine drug screen was negative for cocaine, amphetamines, cannabis, opiates, and benzodiazepines. Ethanol level was not detectable. MRI of the brain was normal.He was started on risperidone 2 mg daily and was given haloperidol and lorazepam as needed to control agitated or psychotic behavior. Over the next 3 days his symptoms gradually resolved, and he was discharged with a diagnosis of Psychotic Disorder NOS. At a follow-up visit two weeks later, his examination was entirely normal, and he related that he had not filled his risperidone prescription after leaving the hospital.A few months later the patient again required admission with a similar acutely psychotic presentation. Medical and laboratory evaluation were again unremarkable. He was treated with haloperidol and lorazepam as needed while his symptoms resolved over the following four days. He was questioned extensively and admitted that he had been prescribed carisoprodol for back spasms and had liked the relaxed feeling he experienced with the drug. He began buying it on the street and ultimately progressed to taking 30 or more tablets daily. He denied misuse of other drugs or alcohol. On the occasions of his two psychotic episodes, he had abruptly stopped taking carisoprodol because he could not obtain it. He had developed anxiety, insomnia, and hallucinations within 48 hours of cessation both times. After this revelation he was treated for substance abuse and has had no recurrence of psychotic symptoms.Meprobamate is a controlled substance with recognized potential for abuse and for withdrawal symptoms with abrupt cessation of intake. It is no longer widely prescribed. Carisoprodol, which is not a controlled substance at the Federal level, is commonly used as a muscle relaxant. However, there is increasing evidence of its abuse potential (3).Almost 20% of individuals with meprobamate withdrawal experience hallucinations or other psychotic symptoms (1), and the previous report of carisoprodol withdrawal involved a patient with vivid hallucinations and bizarre behavior (2). Carisoprodol/meprobamate withdrawal should be considered in the differenti...

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Carisoprodol Withdrawal Syndrome Misdiagnosed as a Psychotic Disorder

Reeves¹,

Ladner²

2008

Annals of Clinical Psychiatry

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“…Several later case reports, however, described carisoprodol abuse and dependence (63-68). These case reports described drug-seeking behaviour, the use of multiple prescribers, escalating doses and clear abstinence symptoms including anxiety, tremor and insomnia after discontinuation (68)(69)(70). No studies have compared the abuse potential of carisoprodol with that of meprobamate, but several authors claim that abuse and dependence, or at least the withdrawal signs following the misuse of carisoprodol, are in fact due to carisoprodol's metabolite meprobamate (66,68,69,71).…”

Section: Abusementioning

confidence: 99%

The role of pharmacoepidemiological studies in the market withdrawal of carisoprodol (Somadril®) in Europe, 167-172

Bramness¹,

Buajordet²

2009

Nor J Epidemiol

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Carisoprodol is a centrally acting muscle relaxant that has been marketed in Europe for more than 45 years. In November 2007 the European Medicines Association recommended suspension of all carisoprodol containing products in all EU countries. During recent years, several observational studies on carisoprodol have been published by our group, which works in the field of traffic medicine and pharmacoepidemiological research in general. In this paper, we review the role pharmacoepidemiological studies on carisoprodol played in providing evidence for the risk of psychomotor impairment and traffic accidents, intoxications and abuse. These issues have been important for decisions about the regulation of carisoprodol.

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“…[1] A few case reports have now been reported in the literature suggesting the addiction potential of carisoprodol.…”

Section: Introductionmentioning

confidence: 99%

Carisoprodol withdrawal syndrome resembling neuroleptic malignant syndrome: Diagnostic dilemma

Paul

Parshotam

Garg

2016

J Anaesthesiol Clin Pharmacol

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Soma (Carisoprodol) is N-isopropyl-2 methyl-2-propyl-1,3-propanediol dicarbamate; a commonly prescribed, centrally acting skeletal muscle relaxant. Neuroleptic malignant syndrome (NMS) is a potentially life-threatening adverse effect of antipsychotic agents. Although diagnostic criteria for NMS have been established, it should be recognized that atypical presentations occur and more flexible diagnostic criteria than currently mandated, may be warranted. We wish to report a postoperative case of bilateral knee replacement who presented with carisoprodol (Soma) withdrawal resembling NMS that was a diagnostic dilemma. Subsequently, it was successfully treated with oral baclofen in absence of sodium dantrolene.

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Carisoprodol Withdrawal Syndrome

Cited by 25 publications

References 15 publications

Carisoprodol Withdrawal Syndrome Misdiagnosed as a Psychotic Disorder

Carisoprodol Withdrawal Syndrome Misdiagnosed as a Psychotic Disorder

The role of pharmacoepidemiological studies in the market withdrawal of carisoprodol (Somadril®) in Europe, 167-172

Carisoprodol withdrawal syndrome resembling neuroleptic malignant syndrome: Diagnostic dilemma

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