Neuroleptic malignant syndrome in a 4-year-old girl associated with alimemazine

Maldegem, Bianca T. van; Smit, L. M. E.; Touw, Daan; Gemke, Reinoud J. B. J.

doi:10.1007/s00431-002-0956-2

Cited by 22 publications

(5 citation statements)

References 9 publications

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“…Symptoms presented by the patients such as fever, rigidity, tachycardia, leukocytosis, diaphoresis, abnormal blood pressure, tachypnea, altered mental status, and elevated CK level are consistent with clinical presentations of other patients with NMS [11]. Remarkably, the development of NMS was preceded by catatonic symptoms such as mutism, refusal of food and fluid intake, and decreased and excesive motor activity.…”

Section: Discussionsupporting

confidence: 73%

Neuroleptic malignant syndrome in an adolescent with CYP2D6 deficiency

et al. 2013

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We describe a patient with dystonia and psychotic symptoms treated with standard doses of antipsychotics, who developed neuroleptic malignant syndrome (NMS). A 16-year-old male with a history of misuse of dextromethorphan and pseudoephedrine for recreational purpose presented with dystonia and a psychotic episode. Following continuous treatment with olanzapine (10 mg/day), repeated injections of levomepromazine (37.5 mg/day), and a single injection of haloperidol (2.5 mg), the patient developed NMS. Muscular rigidity, fever (up to 41 °C), hypotension (100/70 mmHg), tachycardia (120 beats per minute), tachypnea (26 breaths per minute), elevated leukocyte count (up to 16.6 × 103/μL), and elevated serum creatinine phosphokinase (CPK) (up to 15,255 U/L) were observed. A diagnosis of NMS was made according to the DSM-IV TR criteria. Genotyping revealed that he was homozygous for a non-functional CYP2D6*4 allele. The case highlights the importance of therapeutic drug monitoring in identification and differentiation of drug-induced effects in psychiatric disorder to prevent NMS and its complications. In addition, genotyping of CYP2D6 might be considered in patients with symptoms suggestive of drug toxicity who are treated with neuroleptics metabolized via the CYP2D6 pathway, as carriage of one or more non-functional alleles may increase the risk for adverse reactions, such as NMS.

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Section: Discussionsupporting

confidence: 73%

Neuroleptic malignant syndrome in an adolescent with CYP2D6 deficiency

et al. 2013

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“…However, frequent use of alimemazine as a hypnotic in children has been questioned for several reasons [ 15 ]. Alimemazine is not licensed or recommended for use in children less than 2 years old because of indications of highly variable pharmacokinetics [ 24 ], heavy hangovers as a commonly reported side effect [ 25 – 27 ], and a few reports of fatal adverse reactions [ 28 – 32 ]. Although not commonly conducted in children, a few small randomized controlled trials have explored the hypnotic effect of alimemazine [ 33 – 36 ].…”

Section: Discussionmentioning

confidence: 99%

Psychotropic drug use among 0–17 year olds during 2004–2014: a nationwide prescription database study

Hartz¹,

Skurtveit

Steffenak³

et al. 2016

BMC Psychiatry

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BackgroundTime-trend studies on psychotropic drugs among children and adolescents are scarce, and most of them are outdated. The purpose of this study was to study prevalences of psychotropic drug use during 2004–2014 among Norwegians aged <18 years, overall and in psychotropic sub-groups.MethodsData were obtained from the Norwegian Prescription Database, which covers all dispensed prescription drugs in Norway from 2004 and onwards. Psychotropic drugs included: antipsychotics (ATC-group N05A), anxiolytics (N05B), hypnotic/sedatives (N05C), antidepressants (N06A), stimulants (N06BA), and alimemazine (R06AD01). Period (1-year) prevalence of use, overall and in subgroups of psychotropic drugs, was estimated by identifying individuals <18 years who had at least one psychotropic drug dispensed during each year.ResultsPsychotropic drug use increased in 0–17 year olds over an 11-year period, in which the main contributing drugs were stimulants (boys overall; 15.0 to 20.8/1000, girls overall; 3.8 to 8.5/1000), hypnotic/sedative drugs in adolescents (boys overall; 4.2 to 10.8/1000, girls overall; 2.6 to 8.8/1000) and to some extent antidepressants among adolescent girls (girls overall from 3.1 to 4.0/1000). Psychotropic drug use was, however, reduced by half in the youngest children, attributed to reduction of alimemazine only (1-year olds: boys; from 36.6 to 10.2/1000, girls; 26.9 to 7.2/1000). A higher level of psychotropic drug use was observed among younger boys, but there is a shift towards girls using more psychotropic drugs than boys during adolescence for all psychotropic drugs except for stimulants.ConclusionDifferent trends in psychotropic drug use exist in age and gender subgroups. Psychotropic drug use has decreased among the youngest children, attributed to alimemazine, and increased in older children and adolescents, attributed mainly to stimulants and hypnotics/sedatives.

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“…A four-year-old girl developed a malignant neuroleptic syndrome after the use of alimemazine. Her case has been described elsewhere 8. The second concerns a report about a boy aged 14 with atrioventricular re-entry tachycardia after administration of azithromycin for respiratory tract infection and fexofenadine for allergy with a latency period of 8 days (6 days after withdrawal of the azithromycin).…”

Section: Resultsmentioning

confidence: 99%

“…One death occurred in a girl who had received alimemazine as a sedative, which caused the malignant neuroleptic syndrome 8. For the relief of allergic symptoms, the dose is lower than for sedation (0.25 vs 2 mg/kg, respectively) 9…”

Section: Discussionmentioning

confidence: 99%