Acute extrapyramidal reactions following lithium and sulpiride co-administration: Two case reports
✍ Scribed by Timothy G. Dinan; Veronica O'Keane
- Publisher
- John Wiley and Sons
- Year
- 1991
- Tongue
- English
- Weight
- 237 KB
- Volume
- 6
- Category
- Article
- ISSN
- 0885-6222
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✦ Synopsis
Two case reports are presented in which lithium and sulpiride were used jointly in patients with affective disorder. In both cases significant extrapyramidal reactions occurred. The reactions were successfully treated by withdrawing the drug combination. It is suggested that the adverse events relate to the mechanism of action of sulpiride which, unlike other neuroleptics, requires sodium to bind to the dopamine receptor. Lithium may substitute for sodiumenhancing sulpiride binding.
KEY woms-Lithium, sulpiride, extrapyramidal reactions.
Sulpiride is a neuroleptic of the benzamide variety which has potent anti-schizophrenic activity (Edwards et al., 1980) and is more selective than earlier neuroleptics, preferentially blocking the non-adenyl cyclase linked dopamine (D)-2 receptor (Costal1 and Naylor, 1976). In general it has been found to cause fewer extrapyramidal side-effects than traditional neuroleptics (Peselow and Stanley, 1982), presumably due to its cleaner pharmacological profile.
Recently Christie et al. (1989) reported the efficacy of sulpiride in treating acute manic episodes. If sulpiride were to be used in the treatment of mania then clearly any interactions with lithium would be of relevance. The finding of Jenner et al. (1985) that sulpiride, unlike other neuroleptics, increases its binding to D2 receptors in the presence of lithium may have important clinical implications. We report here two cases in which lithium and sulpiride were used jointly, with the development of significant extrapyramidal side-effects.
CASE 1
Case 1 is a 21-year-old admitted to a mother-andbaby unit 3 weeks following the birth of her daughter. The patient was unmarried, unemployed and living at home with her parents. The birth itself was unremarkable and the patient developed symptoms approximately 1 week postpartum. On admission she showed marked lability of mood with