Psychiatry and Clinical Psychopharmacology

Psychopharmacology Angioedema induced by atomoxetine: a case report

Psychiatry and Clinical Psychopharmacology 2013; 23: Supplement S271-S272
Keywords : atomoxetine, angioedema
Read: 761 Published: 17 March 2021

Recently drug using have been rapidly increased and new drugs is used by clinicans. Adverse drug reactions. Increases because drug using is increased too. The most common advers reactions are urticaria, angioedema, anaphylactoid reactions and drug-induced immunologic reactions. Angioedema is a clinic situation that shown often tongue, şoor of the mouth, lips, larynx. C1 esterase inhibitor deficiency, trauma, precipitating factors, such as food or drug allergy can cause angioedema. Atomoxetine is a selective noradrenergic reuptake inhibitor and used for treatment of Attention deficit and hyperactivity disorder (ADHD) in children. In many studies shown that atomoxetine has been well-tolerated drug and has low incidence of side effects. Most common side effects of atomoxetine are abdominal pain, loss of appetite, vomiting, drowsiness, irritability, fatigue, dizziness, and dyspepsia. Some studies found that use of atomoxetine may lead to increase in heart rate and blood pressure. In our case, we aimed to attention that outside of the known side effects of atomoxetine, we detected angioedema in our patient although there is no case in the literature. A 9-year-old female patient, she have referred to our policlinic with complaints of clinic inattention, gradually decreased academic performance, difficulty-doing homework, not being organized. She has had normal level of psychomotor development and had no medical history and family history. She was followed in our clinic with diagnosis of ADHD. Because effective dose of methylphenidate in patient with inadequate response, we have started atomoxetine 18 mg /day, and after 2 weeks, dosage have been increased to 25 mg/day. After following increase in dose atomoxetine treatment, patient who had no dermatological disorder history, have developed to angioedema on lips and tongue, then atomoxetine have been discontinued and anti-edema therapy have been started. Angioedema, hereditary and acquired form, which may be associated with a reaction of choline esterase inhibitor deficiency. It is characterized by a temporary edema in subcutaneous tissues such as lips, tongue, eyelid, intestinal wall and upper respiratory tract. Acquired form of angioedema may occur with many factors such as pollens, foods, drugs, insect bites, light, cold. The most common responsible drugs are NSAID, ACE inhibitors, penicillins and neuromuscular blockers. There is no data in literature about angioedema due to atomoxetine. Tests performed during the pre-treatment and after developing angioedema of the patient and patient’s C1 esterase levels, renal and hepatic function tests were normal. After atomoxetine have been discontinued, patient’s clinics were rapidly improved and she had no any drug history, especially can cause often angioedema such as angiotensin converting enzyme inhibitors, non-steroidal anti-inşammatory drugs. We have considered that reason of angioedema was atomoxetine. The most important feature of angioedema reactions is that it may not develop with first using. In our case is like that too. A review of the relevant literature, this case is remarkable because the first reported case was in the form of pseudoallergic reaction due to atomoxetine angioedema reaction.

EISSN 2475-0581