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Parkinsonism associated with
fluoxetine and cimetidine: a case report.
Leo RJ,
Lichter DG, Hershey LA.
Department of Psychiatry, State
University of New York, Buffalo School of Medicine and Biomedical
Sciences, USA.
Fluoxetine and other selective serotonin reuptake
inhibitors (SSRIs) are effective for the treatment of depression in the
elderly and offer a safer side-effect profile as compared to tricyclics
and monoamine oxidase inhibitors. We report a case in which a patient
treated with fluoxetine developed parkinsonism following the
introduction of cimetidine. Inhibition of hepatic P450 cytochrome
enzymes by cimetidine with an increase in serum levels of norfluoxetine
may have precipitated this extrapyramidal syndrome, which has been
related to agonism of the serotonergic input to nigrostriatal tracts and
basal ganglia. Parkinsonism as a side effect of SSRIs occurs
infrequently, suggesting an idiosyncratic response resulting from a
functional imbalance of serotonergic and dopaminergic activity in
susceptible individuals. Careful monitoring of geriatric patients
treated with fluoxetine is indicated, particularly for those on high
doses, those with impaired hepatic functioning, or those treated with
concurrent medications that slow the metabolism of
fluoxetine.
Publication Types:
PMID: 8561837 [PubMed - indexed for
MEDLINE]
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