Text Version
Entrez PubMed Overview Help | FAQ Tutorial New/Noteworthy E-Utilities
PubMed Services Journals Database MeSH Database Single Citation Matcher Batch Citation Matcher Clinical Queries LinkOut Cubby
Related Resources Order Documents NLM
Gateway TOXNET Consumer
Health Clinical Alerts ClinicalTrials.gov PubMed
Central
Privacy Policy
|
|
-
-
Bupropion-induced acute
dystonia.
Detweiler MB, Harpold
GJ.
Department of Psychiatric Medicine (116A7), Salem
Veterans Affairs Medical Center, University of Virginia, Salem-Roanoke,
1970 Roanoke Blvd., Salem, VA 24153-6478, USA.
Detweiler.Mark_B@Salem.VA.Gov
OBJECTIVE: To report a case of
acute dystonia consisting of neck stiffness, trismus, and unilateral
temporomandibular joint (TMJ) pain and subluxation secondary to an
increase in sustained-release (SR) bupropion. CASE SUMMARY: A
44-year-old white man with a history of chronic low-back pain and
tension headaches, taking no other medications, was started on bupropion
SR 150 mg once a day for depression. The dosage was increased to 150 mg
SR twice a day and eventually augmented with buspirone 15 mg 3 times a
day. He developed bilateral trismus, inability to rotate his head
laterally, and spontaneous left TMJ subluxation. Symptoms recessed with
discontinuation of both medications and failed to reappear with a trial
of buspirone 15 mg 3 times a day alone. A retrial of bupropion alone
evidenced no adverse effects at a dosage of 150 mg SR once a day.
However, when the dosage was increased to 150 mg SR twice a day, the
patient reexperienced initial signs of neck stiffness, jaw muscle
tightness, and left TMJ subluxation within 24-48 hours. Reduction of the
bupropion dosage to 150 mg SR once daily stopped the symptoms; the
patient has continued at this dosage without adverse effects for > 1
year. DISCUSSION: Medication-induced focal dystonias usually present
with dramatic head (most frequently oral-buccal) and neck muscle spasm
with occasional jaw clenching, bruxism, and TMJ syndrome. In this case,
the rapid onset of neck and jaw symptoms within 24-48 hours of an
increase of bupropion SR from 150 mg once a day to 150 mg twice a day
suggest that the patient may have been sensitized by an initial trial of
bupropion and buspirone, or by the increased dose of bupropion alone.
Both agents are reported to interact with both the dopaminergic and
serotonergic systems. Although buspirone has been implicated in inducing
acute dystonia, it did not do so in this case when used alone at a dose
of 45 mg a day. During a second trial of bupropion SR 150 mg a day, neck
and jaw symptoms recurred within 24-48 hours of increasing the dose to
150 mg SR twice a day. The symptoms receded when the bupropion dose was
returned to 150 mg SR once a day, suggesting a dose-response
relationship. The Naranjo probability scale indicated that this untoward
reaction was probable. CONCLUSIONS: This case suggests that selected
patients may experience dose-related acute dystonic adverse reactions to
bupropion with or without buspirone augmentation. Dystonias, which
usually follow administration of antipsychotics, have been linked to
acute dopamine depletion and basal ganglion-derived gamma
synchronization dysfunction. Acute dystonia symptoms may begin within
hours of starting or changing antipsychotic drug dosage; however, 90% of
symptoms are observed during the first 3-5 days of starting or
increasing dosage. To the best of our knowledge, there have been no
reports of bupropion-induced dystonia.
Publication Types:
PMID: 11847943 [PubMed - indexed for
MEDLINE]
|