Dystonic reaction: Difference between revisions
ClaireLewis (talk | contribs) No edit summary |
|||
| Line 28: | Line 28: | ||
==Medications Associated with Dystonic Reaction== | ==Medications Associated with Dystonic Reaction== | ||
*Amitriptyline | *[[Amitriptyline]] | ||
* | *Amoxapine | ||
*Azatadine | *Azatadine | ||
* | *[[Bupropion]] | ||
*Chlorpromazine | *[[Chlorpromazine]] | ||
*Chlorprothixene | *Chlorprothixene | ||
* | *[[Cimetidine]] | ||
*Cisapride | *Cisapride | ||
*Cocaine | *[[Cocaine]] | ||
*Clomipramine | *Clomipramine | ||
*Clozapine | *[[Clozapine]] | ||
*Cyclizine | *Cyclizine | ||
* | *[[Dextromethorphan]] | ||
*Diazepam | *[[Diazepam]] | ||
*Diphenhydramine | *[[Diphenhydramine]] | ||
*Doxepin | *[[Doxepin]] | ||
*Etomidate | *[[Etomidate]] | ||
*Fluoxetine | *[[Fluoxetine]] | ||
*Fluphenazine | *Fluphenazine | ||
*Fluvoxamine | *Fluvoxamine | ||
*Haloperidol | *[[Haloperidol]] | ||
*Imipramine | *Imipramine | ||
*Ketamine | *[[Ketamine]] | ||
*Lozapine | *Lozapine | ||
*Mesoridazine | *Mesoridazine | ||
*Methohexital | *[[Methohexital]] | ||
* | *[[Metoclopramide]] | ||
* | *[[Olanzapine]] | ||
*Paroxetine | *Paroxetine | ||
*Perphenazine | *Perphenazine | ||
*Phenelzine | *Phenelzine | ||
* | *[[Phenytoin]] | ||
*Pimozide | *Pimozide | ||
*Prochlorperazine | *[[Prochlorperazine]] | ||
*Promazine | *Promazine | ||
*Promethazine | *[[Promethazine]] | ||
*Propofol | *[[Propofol]] | ||
* | *[[Quetiapine]] | ||
* | *[[Ranitidine]] | ||
*Risperidone | *[[Risperidone]] | ||
*Sertraline | *Sertraline | ||
*Thiethylperazine | *Thiethylperazine | ||
*Thiopental | *[[Thiopental]] | ||
*Thioridazine | *Thioridazine | ||
*Thiothixene | *Thiothixene | ||
*Tigabine | *Tigabine | ||
* | *Tranylcypromine | ||
*Trifluoperazine | *Trifluoperazine | ||
*Triflupromazine | *Triflupromazine | ||
| Line 94: | Line 94: | ||
**Symptoms will typically begin resolving in 2-15 minutes but may take up to 90 minutes to completely abate (depends on route in which medication was given) | **Symptoms will typically begin resolving in 2-15 minutes but may take up to 90 minutes to completely abate (depends on route in which medication was given) | ||
**Patients may require more than one dose of IV medication before symptoms resolve completely | **Patients may require more than one dose of IV medication before symptoms resolve completely | ||
*Benzodiazepines | *[[Benzodiazepines]] | ||
*Airway Management | *Airway Management | ||
**Rare, but may be indicated in patients with severe respiratory distress from laryngeal or pharyngeal dystoni | **Rare, but may be indicated in patients with severe respiratory distress from laryngeal or pharyngeal dystoni | ||
Revision as of 20:47, 30 September 2019
Background
- Adverse extrapyramidal effect shortly after initiation of new drugs
- intermittent spasmodic or sustained involuntary contractions of muscles
- Rarely life threatening but patient is in distress from pain and discomfort
- Men > Women
Predisposing Factors
- Young age
- Family history of dystonic reaction
- History of EtOH or drug use
- Associated with administration of antiemetics or antipsychotic medications
- 25% of patients treated with Haldol have been known to develop this reaction
- Reaction usually occurs within 48 hrs of drug treatment but can occur up to 5 days after starting therapy
- Severity and onset of reaction depends on an individual, no association with dose, drug type, potency of drug, or duration of treatment
Clinical Features
- History of recent drug exposure or increase in drug dosage (e.g. prescription, over the counter, herbals, illegal)
- Dystonia of any striated muscle group:
- Torticollar reaction
- Buccolingual reaction
- Oculogyric crisis
- Promandibular dystonia
- Lingual dystonia
- Kyphosis/lordosis/scoliosis
- Trismus
- Facial grimacing
- Tortipelvic crisis
Medications Associated with Dystonic Reaction
- Amitriptyline
- Amoxapine
- Azatadine
- Bupropion
- Chlorpromazine
- Chlorprothixene
- Cimetidine
- Cisapride
- Cocaine
- Clomipramine
- Clozapine
- Cyclizine
- Dextromethorphan
- Diazepam
- Diphenhydramine
- Doxepin
- Etomidate
- Fluoxetine
- Fluphenazine
- Fluvoxamine
- Haloperidol
- Imipramine
- Ketamine
- Lozapine
- Mesoridazine
- Methohexital
- Metoclopramide
- Olanzapine
- Paroxetine
- Perphenazine
- Phenelzine
- Phenytoin
- Pimozide
- Prochlorperazine
- Promazine
- Promethazine
- Propofol
- Quetiapine
- Ranitidine
- Risperidone
- Sertraline
- Thiethylperazine
- Thiopental
- Thioridazine
- Thiothixene
- Tigabine
- Tranylcypromine
- Trifluoperazine
- Triflupromazine
Differential Diagnosis
Jaw Spasms
- Acute tetanus
- Akathisia
- Conversion disorder
- Drug toxicity (anticholinergic, phenytoin, valproate, carbamazepine)
- Dystonic reaction
- Electrolyte abnormality
- Hypocalcemic tetany
- Magnesium
- Mandible dislocation
- Meningitis
- Peritonsillar abscess
- Rabies
- Seizure
- Strychnine poisoning
- Stroke
- Temporomandibular disorder
- Torticollis
Evaluation
- Normally a clinical diagnosis
- Consider urine toxicology if no offending agent given by history
Management
- Anticholinergic medication:
- Diphenhydramine: 50-100mg over 2 minutes
- Benztropine: 1-2mg in adults over 2 minutes
- Biperiden
- Trihexyphenidyl 2mg PO BID
- IV > IM > PO
- Symptoms will typically begin resolving in 2-15 minutes but may take up to 90 minutes to completely abate (depends on route in which medication was given)
- Patients may require more than one dose of IV medication before symptoms resolve completely
- Benzodiazepines
- Airway Management
- Rare, but may be indicated in patients with severe respiratory distress from laryngeal or pharyngeal dystoni
Disposition
- Stop the offending agent (if antipsychotic, speak with patients psychiatrist before just stopping the medication)
- Continue to treat with PO anticholinergic to prevent relapse of symptoms
- Diphenhydramine: 12.5-50mg PO TID-QID
- Benztropine: 1-2mg PO BID
References
- Hockberger RS, Richards JR: Thought Disorders; in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. St. Louis, Mosby, Inc., 2014, (Ch) 110: p 1460-1466.