Are there withdrawal symptoms resembling delirium tremens when methyprylon treatment is abruptly s

Fråga: "Are there withdrawal symptoms resembling delirium tremens when methyprylon treatment is abruptly stopped?

Background: Male alcoholic who has been abstinent from alcohol for five years and is currently on disulfiram and propranolol treatment, was taking methyprylon 0.4 gram nightly (two capsules of 0.2 gram). In mid May methyprylon was stopped and propiomazine was started. On June 5 the patient became delirious and violent. "Common sedatives" did not help but clomethiazole did. There is no evidence of recent alcohol-intake."

Sammanfattning: Methyprylon withdrawal may produce symptoms resembling delirium tremens. However, it is not probable that, in this particular case, the symptomatology is associated with methyprylon withdrawal, due to the time lapse involved (two to three weeks).

Svar: Methyprylon is 3,3-diethyl-5-methyl-2,3-piperidinedione, a sedative and hypnotic similar to glutethimide in structure and pharmacologic activity.

Methyprylon withdrawal symtoms are similar to alcohol abstinence: after several hours, apprehension and weakness appear, followed by anxiety, headache, dizziness, tremor, vomiting, nausea, abdominal cramps, insomnia, tachycardia, orthostatic hypotension, convulsions, status epilepticus may develop in the following days; hallucinations and delirium tremens may develop after several days (1). Specific withdrawal symptoms described in case reports include confusion, restlessness, excitement, sweating, polyuria, generalized convulsions, auditory and visual hallucinations and psychotic behaviour (2,3). The symptoms appear within the first days of withdrawal, as expected from the short half-life of the drug (four hours) (4) and its duration of action (up to eight hours) (1).

No cases of withdrawal or dependence to methyprylon have been reported to the National Board of Health in Sweden. On the other hand, consumption of methyprylon is low, 0.3 DDD/1000 inhab/d (0.5 per cent of sales of hypnotics, sedatives and minor tranquilizers in Sweden) (5,6) and its use is not recommended by any of the formulary committees in Sweden (7). 1 Martindale, The extra pharmacopoeia. 1982; 28th ed, The Pharmaceutical Press, London, pp. 792, 807 2 Essig CF: Addiction to nonbarbiturate sedative and tranquilizing drugs. Clin Pharmacol Ther 1964; 5: 334-343 3 Essig CF: Newer sedative drugs that can cause states of intoxication and dependence of barbiturate type. JAMA 1966; 196: 126-129

4 Goodman and Gilman, The pharmacological basis of therapeutics. 1985; 7th ed, MacMillan Publishing Co, New York, p 352
5 Svensk läkemedelsstatistik 1985. Apoteksbolaget, Stockholm, 1986
6 Svensk läkemedelsstatistik 1986. Apoteksbolaget, Stockholm, 1987

7 Läkemedelsboken 87/88. Apoteksbolaget, Stockholm, 1987