A 28-year-old man with a history of cannabis and amphetamine abuse is being treated at a psychiatri

Fråga: A 28-year-old man with a history of cannabis and amphetamine abuse is being treated at a psychiatric ward because of a reactive psychosis. He is also suffering from a periodical bronchial obstruction which responds to inhalation of Ventoline (salbutamol). Earlier treatment with Mallorol (thioridazine) caused nasal obstruction.<br><br>In May 1991 he had breathing difficulties, chest discomfort and an itching exanthema during treatment with Hibernal (chlorpromazine); therefore, the therapy was stopped (dose and duration of chlorpromazine therapy was not specified). In October of the same year he was given Hibernal for a couple of days without any reactions.<br><br>In the beginning of August 1992 treatment with chlorpromazine 50 mg three times daily was started. On the 16th of August the dose was increased to 200 mg three times daily. A few days later he again reported itching and breathing difficulties. A physical examination was, however, normal. Hibernal, he was treated with Rohypnol (flunitrazepam) 2 mg in the evening, Distalgesic (dextropropoxyphene hydrochloride 32.5 mg and paracetamol 325 mg) 1x3 and Nozinan (levomepromazine) 100 mg in the evening. Could the itching and respiratory distress be connected with the chlorpromazine treatment?

Sammanfattning: Different skin reactions including itching are well-known side-effects of chlorpromazine treatment. Except for a single report of a pulmonary hypersensitivity reaction with fever and eosinophilia, there is no information in the literature concerning any respiratory disturbances related to the use of chlorpromazine.

Svar: The use of phenothiazines such as chlorpromazine and levomepromazine is quite frequently associated with different skin reactions. Chlorpromazine is the drug within this group with the highest incidence of dermatological side-effects (1). The Swedish Adverse Drug Reactions Advisory Committee (SADRAC) has received 43 reports of dermatological reactions and itching during chlorpromazine therapy.<br><br>Concerning the other issue, ie whether the pulmonary reaction could be connected with the use of chlorpromazine, we have performed a thorough search in handbooks and on Medline. We have found a single report of a pulmonary hypersensitivity syndrome with infiltrates and eosinophilia during chlorpromazine treatment (2). The register of SADRAC also contains a report of a pulmonary reaction with fever and eosinophilia after three weeks of chlorpromazine therapy. In SADRAC´s judgement, it could not be excluded that the use of chlorpromazine was connected with the symptoms of the patient.<br><br>The use of levomepromazine has not been connected with pulmonary reactions or breathing distress according to information in handbooks, Medline and the register of SADRAC.<br><br>We suggest that this case should be reported to SADRAC.<div id="referenser" style="display:none;">1 Meyler´s, Side effects of drugs. Ed by MNG Dukes. Elsevier, Amsterdam. 1988; 11th ed: 112<br>2 Shear MK: Chlorpromazine-induced PIE syndrome. Am J Psychiatry 1978; 135: 492-493</div>