Chlorpromazine-Induced Neurological Symptoms Mimicking Stroke in an Elderly Patient with Intractable Hiccups: A Case Report
DOI:
https://doi.org/10.61919/jhrr.v4i1.405Keywords:
Chlorpromazine, Intractable Hiccups, Drug-Induced Neurological Symptoms, Antipsychotic Medications, Drug-Induced Stuttering, PharmacotherapyAbstract
Background: Chlorpromazine, a widely utilized antipsychotic medication, has been recognized for its efficacy in treating intractable hiccups through its antagonistic action on histamine H1, dopamine D2, and muscarinic M1 receptors. Despite its therapeutic benefits, there is a spectrum of potential side effects, including neurological symptoms such as drug-induced stuttering, which poses diagnostic challenges and may lead to unnecessary investigations.
Objective: This case study aims to explore the paradoxical effect of chlorpromazine, which, while effectively treating an 80-year-old male patient's intractable hiccups, induced slurred speech and drowsiness, symptoms that resolved upon cessation of the drug.
Methods: A comprehensive evaluation was conducted, involving the patient's clinical presentation, treatment regimen, and the temporal relationship between medication administration and symptom onset. Investigations included a complete blood count, C-reactive protein, liver function tests, COVID-19 antigen test, cardiac workup, and brain MRI. Treatment response and side effects were meticulously documented, with follow-up to assess the resolution of symptoms.
Results: Following the administration of chlorpromazine (50mg orally), the patient's hiccups ceased, but he subsequently developed slurred speech and drowsiness. These symptoms were not present upon initial examination and resolved completely following the discontinuation of chlorpromazine. The brain MRI conducted to explore potential neurological causes was found to be insignificant, reinforcing the diagnosis of drug-induced neurological symptoms.
Conclusion: While chlorpromazine remains a valuable treatment for intractable hiccups, healthcare providers must be vigilant about its potential to induce neurological symptoms. This case highlights the importance of recognizing drug-induced side effects to avoid unnecessary diagnostic procedures and emphasizes the need for ongoing research into the mechanisms underlying such adverse reactions.
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Wu JC, Maguire G, Riley G, Lee A, Keator D, Tang C, Fallon J, Najafi A. Increased dopamine activity associated with stuttering. Neuroreport 1997; 8:767-770.
Anderson JM, Hughes JD, Rothi LJ, Crucian GP, Heilman KM. Developmental stuttering and Parkinson’s disease: the effects of levodopa treatment. J Neurol Neurosurg Psychiatry 1999; 66:776-778.
Nikvarzn N, Sabouris S. Drug - induced stuttering: A comprehensive literature review. World J Psychiatry.2022;12(2):236-263
Deb S, Unwin G, Deb T. Characteristics and the trajectory of psychotropic medication use in general and antipsychotics in particular among adults with an intellectual disability who exhibit aggressive behaviour. J Intellect Disabil Res.2015;59(1):11-25
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Somasetia DH, Sutanto MA, Andriyani FM, Peryoga SU, Hakim DDL. Multi-drugs Abuse Co-ingested with Fake Methanol Beverages in the Indonesian Adolescent: A Case Report. J Drug Alcohol Res. 2021;10(1):236130.
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Motwani S, Murlimanohar K, Karia S, Shah N, Desousa A. Psychogenic Grunting: A Case Report. Indian J Priv Psychiatry. 2020;14(1):41-42.
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