Fentanyl
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Mania: case report A 62-year-old woman received fentanyl 15mg and bupivacaine during knee replacement surgery [route not stated], and was admitted with manic symptoms 3 weeks later. She had become sufficiently functional a couple of days after surgery and had been sent to rehabilitation. There, her condition had gradually progressed to full mania [time to onset not stated]. She had initially become hypomanic, exhibiting hyperactivity and insomnia, but exhibited noncompliance, aggression, disorganisation and agitation on the day of admission. She received haloperidol and diazepam, and achieved complete, stable remission within 3 days. She became calmer, fully organised and able to sleep normally, and expressed the wish to resume rehabilitation. She was discharged after 6 days. Author comment: "There is no evidence that bupivacaine interferes with any excitatory neurotransmitters. Fentanyl, on the other hand, increases cerebral concentration of dopamine and serotonin so there is high possibility that it caused this manic episode by changing metabolism of monoamine neurotransmitters." Medjugorac H, et al. Fentanyl induced organic mania. European Neuropsychopharmacology 21 (Suppl. 3): S444 abstr. P.2.g.007, 3 Sep 2011 803060760 [abstract] - Croatia
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Reactions 1 Oct 2011 No. 1371
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