Promethazine treatment of steroid-induced psychosis in a child.
OBJECTIVE
To report a case of steroid-induced psychosis in a child that resolved with the treatment of promethazine, a phenothiazine derivative.


METHODS
A 2-year-old white boy with a history of relapsed acute lymphoblastic leukemia underwent a bone marrow transplant and developed graft-versus-host disease, which was treated with methylprednisolone. Within 24 hours of initiation of the methylprednisolone, the patient developed symptoms associated with steroid-induced psychosis including mania, head-banging, and excessive crying. Because the corticosteroid could not be discontinued, promethazine, a phenothiazine derivative, was used to treat the psychotic symptoms. Symptoms resolved with use of promethazine.


CONCLUSIONS
A number of published reports describe the appearance of psychological symptoms with corticosteroid use. While the mechanism is unclear, the reaction is usually reversible with dose reduction or discontinuation of the corticosteroid. In cases where this cannot be done, typical treatment involves an antipsychotic medication. Most antipsychotic medications, such as the phenothiazine class, have not been evaluated in very young children. Promethazine is a phenothiazine derivative that has been used in children for a number of nonpsychiatric indications.


CONCLUSIONS
Promethazine may be effective in treating steroid-induced psychosis in pediatric patients.
Ingram
Dena G
DG
College of Pharmacy, University of Oklahoma, Oklahoma City, OK, USA.
Hagemann
Tracy M
TM
D000893:Anti-Inflammatory Agents / Q000009:adverse effects* / Q000627:therapeutic use; D016026:Bone Marrow Transplantation / Q000009:adverse effects; D002675:Child, Preschool; D006086:Graft vs Host Disease / Q000188:drug therapy; D006634:Histamine H1 Antagonists / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008775:Methylprednisolone / Q000009:adverse effects* / Q000627:therapeutic use; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000188:drug therapy; D011398:Promethazine / Q000627:therapeutic use*; D011605:Psychoses, Substance-Induced / Q000188:drug therapy*
D000893:Anti-Inflammatory Agents; D006634:Histamine H1 Antagonists; D011398:Promethazine; D008775:Methylprednisolone