SIMULTANEOUS ABUSE WITH OVERDOSE OF LONG-ACTING RISPERIDONE AND BUPRENORPHINE/NALOXONE IN A NEWLY DIAGNOSED PATIENT WITH BIPOLAR DISORDER: A CASE REPORT
Öz
Background: Atypical antipsychotics are used for the treatment of alcohol-substance use disorders as well as various psychiatric disorders. In this article, a case of simultaneous abuse with an overdose of long-acting risperidone and buprenorphine/naloxone combination in a newly diagnosed patient with bipolar disorder without a history of substance is presented.
Case Presentation: A 34-year-old male abused the combination of long-acting risperidone and buprenorphine/naloxone alternately for 2-3 days (sometimes every day) for 6 months. Euphoria, irritability, logorrhea, insomnia, mild grandiosity, increased psychomotor activity, and anxiety were determined in the psychiatric examination. His marriage and familial relationships were negatively affected, also as economically, too. Serum CK and prolactin levels were high. The pulse was tachycardic. Significant rigidity and tremor were determined on his EPS examination. Affective symptoms regressed after treatment. EPS side effects continued for approximately 8 weeks and decreased gradually after this period.
Conclusions: Although quetiapine is the most commonly abused atypical antipsychotic, risperidone can also be abused among non-substance abusers. Risperidone is abused as an oral formulation, but the long-acting formulation can be abused with overdose as in this case. The level of active risperidone metabolite in serum is lower using the long-acting formulation than in the oral form. This can be advantageous in terms of side effects, especially with overdose. Cardiac side effects are common with overdose and the symptoms related to EPS. The potential for abuse of buprenorphine-naloxone which is used for opioid addiction treatment is low. The buprenorphine-naloxone combination could be abused by people without opioid experience, and other atypical antipsychotics such as risperidone can be abused simultaneously as in this case.
Anahtar Kelimeler
Risperidone long-acting buprenorphine/naloxone bipolar disorder parenteral abuse
Destekleyen Kurum
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Proje Numarası
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Teşekkür
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Kaynakça
- Minns AB, Clark RF. Toxicology and overdose of atypical antipsychotics. J Emerg Med. 2012;43(5), 906-913.
- Işık E, Temel UTG. Klinik Psikofarmakoloji. Ankara: Golden Medya; 2009. p.144-204.
- Kusumi I, Boku S, Takahashi Y. Psychopharmacology of atypical antipsychotic drugs: From the receptor binding profile to neuroprotection and neurogenesis PCN. 2015;69(5), 243-258.
- Nesvåg R, Hendset M. Refsum H, Tanum L. Serum concentrations of risperidone and 9‐OH risperidone following intramuscular injection of long‐acting risperidone compared with oral risperidone medication. Acta Psychiatr Scand. 2006;114(1), 21-26.
- Thyssen A, Rusch S, Herben V, Quiroz J, Mannaert E. Risperidone Long‐Acting Injection: Pharmacokinetics Following Administration in Deltoid Versus Gluteal Muscle in Schizophrenic Patients. The Journal of Clinical Pharmacology. 2010;50(9), 1011-1021.
- Zhornitsky S, Rizkallah E, Pampoulova T, Chiasson JP, Stip E, et al. Antipsychotic agents for the treatment of substance use disorders in patients with and without comorbid psychosisJ Clin Psychopharmacol. 2010;30(4), 417-424.
- Brunetti M, Di Tizio L, Dezi S, Pozzi G, Grandinetti P, et al. Aripiprazole, alcohol, and substance abuse: a review. Eur Rev Med Pharmacol Sci. 2012;16(10), 1346-1354.
- Evoy KE, Teng C, Encarnacion VG, Frescas B, Hakim J, et al. Comparison of quetiapine abuse and misuse reports to the FDA Adverse Event Reporting System with other second-generation antipsychotics. Subst Abuse. 2019;13, 1178221819844205.
- Malekshahi T, Tioleco N, Ahmed N, Campbell AN, Haller D. Misuse of atypical antipsychotics in conjunction with alcohol and other drugs of abuse. J Subst Abuse Treat. 2015;48(1), 8-12.
- Klein L, Bangh S, Cole JB. Intentional recreational abuse of quetiapine compared to other second-generation antipsychotics. West J Emerg Med. 2017;18(2), 243.
- Alho H, Sinclair D, Vuori E, Holopainen A. Abuse liability of buprenorphine–naloxone tablets in untreated IV drug users. Drug Alcohol Depend. 2007;88(1), 75-78.
- Mammen K, Bell J. The clinical efficacy and abuse potential of combination buprenorphine–naloxone in the treatment of opioid dependence. Expert Opin Pharmacother. 2009;10(15), 2537-2544.
- Ugurlu TT, Sengül CB, Sengül C. Bagimlilik Psikofarmakolojisi/Psychopharmacology of Addiction. Psikiyatride Guncel Yaklasimlar. 2012;4(1), 37.
- Khantzian EJ. The self-medication hypothesis of addictive disorders: focus on heroin and cocaine dependence. In the cocaine crisis. Springer, Boston, MA; 1987. p.65-74.
- Comer SD, Sullivan MA, Vosburg SK, Manubay J, Amass L, et al. Abuse liability of intravenous buprenorphine/naloxone and buprenorphine alone in buprenorphine‐maintained intravenous heroin abusers. Addiction. 2010;105(4), 709-718.
- Jones JD, Sullivan MA, Vosburg SK, Manubay JM, Mogali S, et al. Abuse potential of intranasal buprenorphine versus buprenorphine/naloxone in buprenorphine‐maintained heroin users. Addict Biol. 2015;20(4), 784-798.
- Simojoki K, Alho H. Finnish experience with buprenorphine-naloxone combination (Suboxone®): survey evaluations with intravenous drug users. Heroin Addict Relat Clin Probl. 2008;10, 33-36.
- McCance‐Katz EF, Sullivan LE, Nallani S. Drug interactions of clinical importance among the opioids, methadone and buprenorphine, and other frequently prescribed medications: a review. Am J Addict. 2010;19(1), 4-16.
- Riedel M, Schwarz MJ, Strassnig M, Spellmann I, Müller–Arends A, et al. Risperidone plasma levels, clinical response and side–effects. Eur Arch Psychiatry Clin Neurosci. 2005;255(4), 261-268.
- Pollak PT, Verjee ZH, Lyon AW. Risperidone-induced QT prolongation following overdose correlates with serum drug concentration and resolves rapidly with no evidence of altered pharmacokinetics. J Clin Pharmacol. 2011;51(7), 1112.
- Malik AR, Wolf PK, Ravasia S. Hypokalemia from risperidone and quetiapine overdose. Can J Psychiatry. 2005;50(1), 76-76.
- Rassam S, Srinivasa R. Respiratory depression after accidental risperidone overdose. The American Journal of Emergency Medicine. 2002;20(6), 570.
- Akyol A, Senel AC, Ulusoy H, Karip F, Erciyes N. Delayed respiratory depression after risperidone overdose. Anesth Analg. 2005;101(5), 1490-1491.
- Capel MM, Colbridge MG, Henry JA. Overdose profiles of new antipsychotic agents. Int J Neuropsychopharmacol. 2000;3(1), 51-54.
- Page CB, Calver LA, Isbister GK. Risperidone overdose causes extrapyramidal effects but not cardiac toxicity. J Clin Psychopharmacol. 2010;30(4), 387-390.
- Pasha S, Schilling S. Unintentional overdose on long-acting injectable risperidone. CNS Spectr. 2018;23(01):104-105.
- Ojimba C, Oyelakin A, Khandaker T. Accidental overdose of paliperidone palmitate. Case Rep Psychiatry. 2019.
YENİ TANI KONMUŞ BİPOLAR BOZUKLUĞU OLAN BİR HASTADA YÜKSEK DOZDA UZUN ETKİLİ RİSPERİDON VE BUPRENORFİN/NALOKSONUN EŞ ZAMANLI KÖTÜYE KULLANIMI: BİR OLGU SUNUMU
Öz
Arka plan: Atipik antipsikotikler çeşitli psikiyatrik bozuklukların yanı sıra alkol-madde kullanım bozukluklarının tedavisinde de kullanılmaktadır. Bu makalede, daha önce madde kullanım öyküsü olmayan yeni tanı almış bipolar bozukluğu olan bir hastada yüksek dozda uzun etkili risperidon ve buprenorfin/nalokson kombinasyonunun eş zamanlı kötüye kullanım vakası sunulmuştur.
Olgu Sunumu: 34 yaşında erkek hasta, 6 ay boyunca ortalama 2-3 günde bir (bazen her gün) dönüşümlü olarak uzun etkili parenteral risperidon ve buprenorfin/nalokson kombinasyonunu kötüye kullanmıştı. Yapılan psikiyatrik muayenede öfori, irritabilite, logore, uykusuzluk, hafif grandiyözite, artmış psikomotor aktivite ve anksiyete tespit edildi. Evliliği, aile ilişkileri ve ekonomik durumu olumsuz etkilenmişti. Serum CK ve prolaktin düzeyleri yüksekti. Nabız taşikardikti. Ekstrapiramidal sistem (EPS) muayenesinde belirgin rijidite ve tremor saptandı. Tedavi sonrasında afektif semptomlar geriledi. EPS yan etkileri yaklaşık 8 hafta boyunca devam etti ve bu süreden sonra giderek azaldı.
Sonuçlar: En sık kötüye kullanılan atipik antipsikotik ketiapin olmasına rağmen, risperidon madde bağımlısı olmayan kişiler arasında da kötüye kullanılabilmektedir. Risperidonun genellikle oral formu olarak kötüye kullanılmaktadır, ancak bu vakada olduğu gibi uzun etkili formülasyon da yüksek dozda kötüye kullanılabilir. Serumdaki aktif risperidon metaboliti seviyesi, oral forma göre uzun etkili formülasyon kullanıldığında daha düşüktür. Bu, özellikle aşırı dozda yan etkiler açısından avantajlı olabilir. Kardiyak yan etkiler yüksek dozda ve EPS ile ilgili semptomlarda yaygındır. Opioid bağımlılığı tedavisinde kullanılan buprenorfin-naloksonun kötüye kullanım potansiyeli düşüktür. Buprenorfin-nalokson kombinasyonu opioid deneyimi olmayan kişiler tarafından kötüye kullanılabilir ve bu vakada olduğu gibi risperidon gibi diğer atipik antipsikotikler ile eş zamanlı olarak kötüye kullanılabilir.
Anahtar Kelimeler
uzun etkili bipolar bozukluk buprenorfin/nalokson kötüye kullanım risperidon parenteral
Proje Numarası
-
Kaynakça
- Minns AB, Clark RF. Toxicology and overdose of atypical antipsychotics. J Emerg Med. 2012;43(5), 906-913.
- Işık E, Temel UTG. Klinik Psikofarmakoloji. Ankara: Golden Medya; 2009. p.144-204.
- Kusumi I, Boku S, Takahashi Y. Psychopharmacology of atypical antipsychotic drugs: From the receptor binding profile to neuroprotection and neurogenesis PCN. 2015;69(5), 243-258.
- Nesvåg R, Hendset M. Refsum H, Tanum L. Serum concentrations of risperidone and 9‐OH risperidone following intramuscular injection of long‐acting risperidone compared with oral risperidone medication. Acta Psychiatr Scand. 2006;114(1), 21-26.
- Thyssen A, Rusch S, Herben V, Quiroz J, Mannaert E. Risperidone Long‐Acting Injection: Pharmacokinetics Following Administration in Deltoid Versus Gluteal Muscle in Schizophrenic Patients. The Journal of Clinical Pharmacology. 2010;50(9), 1011-1021.
- Zhornitsky S, Rizkallah E, Pampoulova T, Chiasson JP, Stip E, et al. Antipsychotic agents for the treatment of substance use disorders in patients with and without comorbid psychosisJ Clin Psychopharmacol. 2010;30(4), 417-424.
- Brunetti M, Di Tizio L, Dezi S, Pozzi G, Grandinetti P, et al. Aripiprazole, alcohol, and substance abuse: a review. Eur Rev Med Pharmacol Sci. 2012;16(10), 1346-1354.
- Evoy KE, Teng C, Encarnacion VG, Frescas B, Hakim J, et al. Comparison of quetiapine abuse and misuse reports to the FDA Adverse Event Reporting System with other second-generation antipsychotics. Subst Abuse. 2019;13, 1178221819844205.
- Malekshahi T, Tioleco N, Ahmed N, Campbell AN, Haller D. Misuse of atypical antipsychotics in conjunction with alcohol and other drugs of abuse. J Subst Abuse Treat. 2015;48(1), 8-12.
- Klein L, Bangh S, Cole JB. Intentional recreational abuse of quetiapine compared to other second-generation antipsychotics. West J Emerg Med. 2017;18(2), 243.
- Alho H, Sinclair D, Vuori E, Holopainen A. Abuse liability of buprenorphine–naloxone tablets in untreated IV drug users. Drug Alcohol Depend. 2007;88(1), 75-78.
- Mammen K, Bell J. The clinical efficacy and abuse potential of combination buprenorphine–naloxone in the treatment of opioid dependence. Expert Opin Pharmacother. 2009;10(15), 2537-2544.
- Ugurlu TT, Sengül CB, Sengül C. Bagimlilik Psikofarmakolojisi/Psychopharmacology of Addiction. Psikiyatride Guncel Yaklasimlar. 2012;4(1), 37.
- Khantzian EJ. The self-medication hypothesis of addictive disorders: focus on heroin and cocaine dependence. In the cocaine crisis. Springer, Boston, MA; 1987. p.65-74.
- Comer SD, Sullivan MA, Vosburg SK, Manubay J, Amass L, et al. Abuse liability of intravenous buprenorphine/naloxone and buprenorphine alone in buprenorphine‐maintained intravenous heroin abusers. Addiction. 2010;105(4), 709-718.
- Jones JD, Sullivan MA, Vosburg SK, Manubay JM, Mogali S, et al. Abuse potential of intranasal buprenorphine versus buprenorphine/naloxone in buprenorphine‐maintained heroin users. Addict Biol. 2015;20(4), 784-798.
- Simojoki K, Alho H. Finnish experience with buprenorphine-naloxone combination (Suboxone®): survey evaluations with intravenous drug users. Heroin Addict Relat Clin Probl. 2008;10, 33-36.
- McCance‐Katz EF, Sullivan LE, Nallani S. Drug interactions of clinical importance among the opioids, methadone and buprenorphine, and other frequently prescribed medications: a review. Am J Addict. 2010;19(1), 4-16.
- Riedel M, Schwarz MJ, Strassnig M, Spellmann I, Müller–Arends A, et al. Risperidone plasma levels, clinical response and side–effects. Eur Arch Psychiatry Clin Neurosci. 2005;255(4), 261-268.
- Pollak PT, Verjee ZH, Lyon AW. Risperidone-induced QT prolongation following overdose correlates with serum drug concentration and resolves rapidly with no evidence of altered pharmacokinetics. J Clin Pharmacol. 2011;51(7), 1112.
- Malik AR, Wolf PK, Ravasia S. Hypokalemia from risperidone and quetiapine overdose. Can J Psychiatry. 2005;50(1), 76-76.
- Rassam S, Srinivasa R. Respiratory depression after accidental risperidone overdose. The American Journal of Emergency Medicine. 2002;20(6), 570.
- Akyol A, Senel AC, Ulusoy H, Karip F, Erciyes N. Delayed respiratory depression after risperidone overdose. Anesth Analg. 2005;101(5), 1490-1491.
- Capel MM, Colbridge MG, Henry JA. Overdose profiles of new antipsychotic agents. Int J Neuropsychopharmacol. 2000;3(1), 51-54.
- Page CB, Calver LA, Isbister GK. Risperidone overdose causes extrapyramidal effects but not cardiac toxicity. J Clin Psychopharmacol. 2010;30(4), 387-390.
- Pasha S, Schilling S. Unintentional overdose on long-acting injectable risperidone. CNS Spectr. 2018;23(01):104-105.
- Ojimba C, Oyelakin A, Khandaker T. Accidental overdose of paliperidone palmitate. Case Rep Psychiatry. 2019.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Klinik Tıp Bilimleri |
| Bölüm | Olgu Sunumları |
| Yazarlar | |
| Proje Numarası | - |
| Yayımlanma Tarihi | 14 Mart 2024 |
| Yayımlandığı Sayı | Yıl 2024 Sayı: 1 |
