Panic Attack Following Addition of Nalmefene to Methylphenidate in a Patient with Comorbid Alcohol Use Disorder and Attention Deficit Hyperactivity Disorder: A Case Report
Journal Title: International Journal of Medical and Pharmaceutical Case Reports - Year 2017, Vol 9, Issue 3
Abstract
Aim: Our aim is to describe a previously unreported potential interaction of nalmefene with methylphenidate and discuss possible mechanisms and precautions. Presentation of Case: A 40-year-old man with ADHD taking long-acting methylphenidate developed alcohol use disorder. Nalmefene was prescribed. Following his first bedtime administration, he awoke with panic attack symptoms and concomitant suicidal and homicidal ideation. These symptoms resolved 45 minutes after he received diazepam. Discussion: Hypotheses for this reaction include a previously undescribed nalmefene–methylphenidate interaction causing elevated levels of either drug and leading to anxiety and panic symptoms, dysphoria, and suicidal/homicidal ideation. ADHD and alcohol abuse disorder are common comorbidities and treatment with both methylphenidate and nalmefene is a reasonable approach. Conclusions: The patient described in this case had not previously reported any of these adverse events, reported them on the first and only occasion of ingesting methylphenidate and nalmefene on the same day, and has not reported them since, suggesting that the adverse events may have been associated with a drug–drug interaction. However, our experience with this case suggests that further research is required on this potential interaction and that clinicians should be aware of this potential interaction and use caution in prescribing this combination.
Authors and Affiliations
Arda Karagöl
Keywords
Related Articles
- EP ID EP309672
- DOI 10.9734/IJMPCR/2017/34856
- Views 96
- Downloads 0
Myocardial Infarction in a Young African Male Using Protein Supplements Rich in Branched Chain Amino Acids & Creatine
Aims: Myocardial Infarction is more likely to inflict patients with major cardiovascular risk factors. Sometimes we come across a few patients with myocardial infarction who doesn’t have any of the typical risk factors f...
New Onset Generalized Tonic Clonic Seizures after Intravenous Tramadol with Ondansetron
Aims: Tramadol hydrochloride is a centrally acting opioid analgesic. Ondansetron is a selective serotonin receptor (5-HT3) antagonist, primarily used for prevention and treatment of drug-induced and postoperative nausea...
How to Manage an Anticoagulated Patient in Case of Drug-Drug Interaction?
Aims: The aim of this publication is to present the case of management of a patient on anticoagulation therapy with rivaroxoban in the context of a drug-drug interaction. Presentation of Case: We report the case of a 73-...
Osteoporosis Reduction in Pre and Postmenopausal Women Using a High Intensity Exercise Program
Aim: This manuscript describes how a weekly high intensity weight lifting exercise regimen was able to improve the osteoporotic state in women with a previous diagnosis of low bone mineral density. Case Presentation: Thi...
Thyroid Hyalinizing Trabecular Tumor: A Case Series
Aim: Hyalinizing Trabecular Tumor (HTT) of the thyroid gland is an unusual and rare follicular derived neoplasm, which was first described from Carney and colleagues in 1987. We aim to present two cases of HTT diagnosed...