Frågedatum: 2001-06-11
RELIS database 2001; id.nr. 17679, DRUGLINE
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Is pre-existing psychosis a risk factor for neuropsychiatric toxicity of interferon alpha?/nThe que



Fråga: Is pre-existing psychosis a risk factor for neuropsychiatric toxicity of interferon alpha? The question concerns a 51-year-old man with schizophrenia, diabetes and hepatitis C. Treatment with Introna (interferon alpha-2b) is being considered.

Sammanfattning: Neuropsychiatric symptoms are known adverse reactions of interferon alpha. In the literature there are some indications that patients with pre-existing neurologic or psychiatric disorders might be at a higher risk of developing neuropsychiatric side effects of treatment with interferon alpha.

Svar: Neuropsychiatric complications, including depression, anxiety, confusion and ataxia, have been reported in patients treated with varying doses of interferon alpha for a variety of conditions including cancer and hepatitis (1). Information regarding treatment of interferon alpha in patients with pre-existing neuropsychiatric disorders is, however limited. In a prospective phase II trial (2) Martee et al. studied the risk factors for severe neuropsychiatric toxicity in 91 patients with chronic myelogenous leukaemia being treated with a combination of interferon alpha and cytarabine. In total, 22 patients developed severe neuropsychiatric toxicity, which resolved upon withdrawal of the drug. Twelve of 19 patients with pre-treatment neurologic or psychiatric diagnosis developed severe neuropsychiatric toxicity, as compared with 10 of 72 patients without pre-treatment neurologic or psychiatric diagnosis.

In another study (3), that addressed the neuropsychiatric complications of interferon alpha in patients with chronic hepatitis, three of 58 patients developed delirium. Two patients had a history of psychiatric illness, and the third had a history of drug and alcohol abuse. All three patients recovered after withdrawal of interferon alpha.

According to FASS 2000 (4), patients with psychiatric disease or with pre-existing neuropsychiatric disorder should not be treated with interferon alpha. Central nervous system reactions such as confusion, dizziness and depression are listed in FASS as common adverse drug reactions.

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