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 90
- Downloads 0
Metoprolol-induced Psoriasiform Drug Eruption: A Case Report
Aim: We report the case of drug-induced psoriasiform eruptions in a middle aged known hypertensive and diabetic woman being treated for paroxysmal cardiac arrhythmias with metoprolol. Case Presentation: A 58-year-old kno...
Abdominal Pregnancy a Report of Two Cases
Background: Abdominal pregnancy is a rare condition and potentially life-threatening if not diagnosed early and treated adequately. It has a high maternal and foetal mortality. Two cases of abdominal pregnancy are discus...
External Auditory Canal Fracture after Posterior Dislocation of an Intact Condylar Head
Aims: The aim of this article is the kind of applied treatment for fracture of the external auditory canal, following traumatic facial injuries. Presentation of Case: The case report of the patient described in this art...
Neonatal Abstinence Syndrome due to In-utero Exposure to Gabapentin: A Case Report
We report the case of a neonate who likely developed symptoms of Neonatal Abstinence Syndrome after in-utero exposure to gabapentin for treatment of maternal chronic pain. The neonate developed symptoms of hypertonicity,...
Sustained-Release Bupropion Overdose: A Case Report
Bupropion is an atypical antidepressant with a unique aminoketone structure similar to amphetamines. A narrow therapeutic margin is evident from observational studies that show seizure activity with doses of 400-600 mg o...