Antihypertensives
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Lack of efficacy, psychiatric and neuropsychiatric side effects: case report A 59-year-old woman developed depression and insomnia during treatment with enalapril and valsartan. She additionally developed neuropsychiatric side effects during treatment with losartan, and exhibited lack of effect of eplerenone, indicated for hypertension [routes, times to reactions onsets and outcomes not stated; not all dosages stated]. The woman presented with extreme thirst. She was a smoker (35 pack-years) and had significant history of peripheral vascular disease, including symptomatic carotid artery stenosis. She had been receiving nifedipine for hypertension. She had a gradual worsening of thirst in past 6 months. During an outpatient evaluation, she exhibited polydipsia and polyuria. She also developed worsening BP, hyponatraemia and hypokalaemia. She received treatment with enalapril and valsartan. However, she developed depression and insomnia due to enalapril and valsartan. Enalapril and valsartan were discontinued. She started receiving eplerenone 100mg once daily, and concomitant sodium and potassium supplementation [specific drugs not stated]. However, this treatment did not relieve her symptoms, nor corrected her electrolyte disorders and hypertension. She was hospitalised for further treatment. Eplerenone was discontinued. She received oral potassium supplementation. Following investigations, she was diagnosed with hyponatraemic-hypertensive syndrome (HHS), and started receiving losartan. However, she experienced neuropsychiatric side effects due to losartan. Losartan was switched to aliskiren. Subsequently, her BP normalised. At the time of report, her underlying hypertension was controlled with aliskiren and nifedipine. Hoorn EJ, et al. The Case , A 59-year-old woman with pressing thirst. Kidney International 96: 1245-1246, No. 5, Nov 2019. Available from: URL: http://doi.org/10.1016/ j.kint.2019.03.027 803499878
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Reactions 5 Sep 2020 No. 1820
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