Mirtazapine Induced Tremors: A Case Report

Uvais, N. A.; Sreeraj, VS; Shihabudheen, P.; Mohammed, Tahseen

doi:10.4103/ijpsym.ijpsym_436_18

Cited by 3 publications

(6 citation statements)

References 10 publications

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“…All of the patient’s regular medications except for inhalers, anticoagulation, and nutritional supplements were held in the first 24 h. Although mirtazapine is known to cause psychomotor agitation and other forms of hyperkinesia when reduced clearance is present, there are no published reports of mirtazapine toxicity causing chorea. 9 , 10 There were also no identifiable agents that are known to induce chorea upon their withdrawal.…”

Section: Discussionmentioning

confidence: 99%

Transient bilateral chorea secondary to digoxin toxicity in a female with acute kidney injury: a case report

Mannion

Tariq

Owens

2021

European Heart Journal - Case Reports

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Background Chorea secondary to digoxin toxicity is rare, with only three published cases describing the phenomenon. We report the case of a 78-year-old female presenting with intermittent vomiting and diarrhoea for 4 weeks. She had a history of chronic kidney disease and digoxin use for atrial fibrillation. Case summary A 78-year-old lady presented to the emergency department with a 4-week history of intermittent vomiting and diarrhoea. These symptoms commenced after a course of antibiotics prescribed by her general practitioner for a urinary tract infection. Her admission electrocardiogram demonstrated atrial fibrillation at a rate of 32, with evidence of digitalis toxicity. Her creatinine was 396 µmol/L (44–80 µmol/L) with digoxin level 8.1 nmol/L (0.77–1.5 nmol/L). Initially, treatment was with digoxin-specific antibody (FAB) and fluid resuscitation. Within 24 h, she developed transient head, neck, and bilateral upper limb chorea. Review of medications revealed no other likely causative agent. Neuroimaging showed no new ischaemia, but stable established bilateral infarcts of the basal ganglia. Haloperidol 0.5 mg twice daily was commenced. Three days later as digoxin levels normalized, the chorea resolved entirely without recurrence. Discussion We have identified three reported cases of digoxin-induced chorea. Our case resembles two of the published cases where a transient bilateral chorea, associated with digitalis toxicity and resolving within a few days of normalization of digoxin levels was demonstrated. There were no other focal neurological signs or symptoms. It has been postulated that an alteration to dopaminergic neuronal activity is a potential mechanism, as digoxin also demonstrates neuropsychiatric side effects such as psychosis and depression.

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Section: Discussionmentioning

confidence: 99%

Transient bilateral chorea secondary to digoxin toxicity in a female with acute kidney injury: a case report

Mannion

Tariq

Owens

2021

European Heart Journal - Case Reports

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“…and Uvais et al . did not clearly describe the neurological examination, and they lack information about the characterization of bradykinesia [ 57 63 ]. Therefore, even though the diagnosis of parkinsonism in those cases is possible, we believe that a diagnosis of an exacerbation of physiological tremor, which can be explained by the increase of NE release in a situation such as stress and anxiety, is more probable more probable [ 95 ].…”

Section: Discussionmentioning

confidence: 99%

“…Or even another possible pathway correlated with the RLS/AKT mechanisms can be suspected. One supporting feature of this theory is the fact that the general description of the patients' symptoms [ 63 ]. Moreover, the PLMD may also be related in the same way as tremor and RLS/AKT overlap pathways [ 97 ].…”

Section: Discussionmentioning

confidence: 99%

“…For 1990 and 2019, a total of 52 reports containing 179 individuals that developed a MD associated with MTZ were identified from 20 different countries [ Table 1 ] [ 10 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 ]. 103 individuals were from European countries, 49 Asian, 17 Australian, 8 North American, and 2 South American.…”

Section: R Esultsmentioning

confidence: 99%

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Mirtazapine-associated movement disorders: A literature review

Rissardo

Caprara

2020

Tzu Chi Med J

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Mirtazapine (MTZ) is an atypical antidepressant approved by the FDA, which mechanism of action involves the antagonism of alpha-2, H1, 5-HT2A, 5-HT2C, and 5-HT3 receptors. In this context, the aim of this literature review is to evaluate the clinical epidemiological profile, pathological mechanisms, and management of MTZ-associated movement disorders (MDs). Relevant reports of six databases were identified and assessed by two reviewers without language restriction. Fifty-two reports containing 179 cases from 20 countries were assessed. The mean age was 57 year (range, 17–85). The majority of the individuals were female (60%) and of European origin. The mean time from MTZ start to symptom onset was 7.54 days; the time from management to MD improvement was within one week in 82.60% of the individuals. The MDs associated with MTZ were 69 restless legs syndrome (RLS), 35 tremors, 10 akathisia (AKT), 9 periodic limb MD, 6 dystonia, 4 rapid eye movement sleep behavior disorders, 3 dyskinesia, 2 parkinsonism, and 1 tic, and in the group not clearly identified, 18 restlessness, 15 hyperkinesis, and 1 extrapyramidal symptom. In the literature, the majority of the reports lack important information about the neurological examination. The management should be the MTZ withdrawal, except in RLS that other options are possible. In AKT, the MTZ should not be rechallenge, and if available, the prescription of a benzodiazepine may reduce recovery time.

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“…Antidepressants are generally metabolized in the liver and excreted through the feces and urine with an elimination half‐life within a few hours to a few days [7–9]. The antidepressant adverse effects include anxiety, nausea, nervousness, somnolence, sexual dysfunction, dry mouth, tremor, and abnormal dreams [10–12]. Self‐medication and overuse of these drugs in depressed people are significant problems [13]; in many cases, these cause poisoning and sometimes death [14, 15].…”

Section: Introductionmentioning

confidence: 99%

Preconcentration and determination of five antidepressants from human milk and urine samples by stir bar filled magnetic ionic liquids using liquid–liquid–liquid microextraction‐high‐performance liquid chromatography

Taghizadeh

Ebrahimi

Fooladi³

et al. 2022

J of Separation Science

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A sensitive and straightforward liquid-liquid-liquid microextraction method was developed to preconcentrate and cleanup antidepressants, including mirtazapine, venlafaxine, escitalopram, fluoxetine, and fluvoxamine, from biological samples before analyzing with high-performance liquid chromatography. The essential novelty of this study is using magnetic ionic liquids as the extraction phase in the lumen of hollow fiber and preparing a liquid magnetic stir bar. In this method, polypropylene hollow fiber was utilized as the permeable membrane for the analyte extraction. Six magnetic ionic liquids consisting of the transition metal and rare earth compounds were synthesized and then hollow fiber lumen was injected as acceptor phase to extract the antidepressants. Besides, 3-pentanol as a water-immiscible solvent was impregnated in the hollow fiber wall pores. The effective factors in the method were optimized with the central composition design. The resultant calibration curves were linear over the concentration range of 0.8-400.0 ng mL −1 (R 2 ≥ 0.996). The method displayed the proper detection limit (0.11-0.24 ng mL −1 ), the reasonable limit of quantification (≤0.79 ng mL −1 ), wide linear ranges, high preconcentration factors (≥294.3), and suitable relative standard deviation (2.31-5.47%) for measuring antidepressant medications. Analysis of human milk and urine samples showed acceptable recoveries of 96.5-103.8% with excellent relative standard deviations lower than 5.95%.

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Mirtazapine Induced Tremors: A Case Report

Cited by 3 publications

References 10 publications

Transient bilateral chorea secondary to digoxin toxicity in a female with acute kidney injury: a case report

Transient bilateral chorea secondary to digoxin toxicity in a female with acute kidney injury: a case report

Mirtazapine-associated movement disorders: A literature review

Preconcentration and determination of five antidepressants from human milk and urine samples by stir bar filled magnetic ionic liquids using liquid–liquid–liquid microextraction‐high‐performance liquid chromatography

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