Haloperidol/levothyroxine-sodium interaction
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Myoclonus and pancytopenia : case report A 94-year-old woman developed myoclonus and pancytopenia during treatment with haloperidol. The interaction between haloperidol and levothyroxine sodium also facilitated the development of myoclonus and pancytopenia [not all routes and dosages stated]. The woman, who had a complex medical history including chronic renal failure stage II, was admitted to the emergency room due to deep asthenia. She had been receiving chronic therapy with levothyroxine sodium [levothyroxine] for hypothyroidism, along with unspecified antihypertensives, proton pump inhibitors and thiazide diuretics. On admission, she was noted to have systemic dehydration, which was thought to be related to a very low oral water intake and unspecified thiazide diuretics. She was then diagnosed with an acute exacerbation of chronic renal failure due to severe dehydration. She was therefore started on IV fluid therapy with 0.9% sodium chloride [NaCL]. During the first night of her hospital admission, she developed severe agitation, which was interpreted as hyperkinetic delirium. She was then started on IM haloperidol 1mg, which showed partial response. After a few hours of the administration of haloperidol, she developed rapid and involuntary movements of the four limbs with motor restlessness and inability to remain relaxed. The woman was given IV lorazepam with transient recovery. The seizure was suspected; however, electroencephalogram ruled out seizures. She was then diagnosed with haloperidol-induced myoclonus. She was treated with clonazepam and showed a good clinical response. During admission, she also had transient pancytopenia, which was characterised by mild leukopenia, moderate anaemia and severe thrombocytopenia. She also developed a single episode of self-limiting nosebleed. Haloperidol was stopped. The pancytopenia was treated with platelets, RBC transfusions and IV steroids with subsequent normalisation of laboratory parameters. Based on the presentation, a likely diagnosis of haloperidol-induced pancytopenia was made. After 14 days of hospital stay, she was discharged. It was considered that, the interaction between haloperidol and levothyroxine sodium might also have contriuted to the onset of myoclonus and pancytopenia. Remelli F, et al. An unwanted reaction by the use of Haloperidol in hyperkinetic delirium. Aging Clinical and Experimental Research : 2020. Available from: URL: http:// 803507023 doi.org/10.1007/s40520-020-01649-2
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Reactions 17 Oct 2020 No. 1826
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