Withdrawal from high-dose tranylcypromine.
A 34-year-old man with a history of multiple substance abuse (now abstinent for six years) became addicted to tranylcypromine, consuming up to 240 mg/day. After discontinuing the drug, he developed thrombocytopenia (52,000/ul) and delirium; there were no other anticholinergic signs. The delirium was unresponsive to haloperidol and diazepam. Intravenous administration of physostigmine (2 mg) on hospital day 6 resulted in prompt, but temporary, clearing of the delirium. Following a recurrence of the delirium after 30 minutes, he was started on an intravenous infusion of physostigmine (2 mg/hr) with good results. Physostigmine administration did not produce any cholinergic signs. By hospital day 8, he did not require any more physostigmine. Thrombocytopenia resolved on hospital day 9 without therapeutic intervention. On hospital day 10, the patient was asymptomatic and left the hospital on his own recognizance.
Eyer
F
F
Department of Toxicology, Klinikum rechts der Isar, München, Germany.
Jetzinger
E
E
Pfab
R
R
Zilker
T
T
D000328:Adult; D000931:Antidotes / Q000008:administration & dosage / Q000627:therapeutic use; D003693:Delirium / Q000523:psychology; D006556:Heroin Dependence / Q000150:complications; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008881:Migraine Disorders / Q000188:drug therapy; D008996:Monoamine Oxidase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D010830:Physostigmine / Q000008:administration & dosage / Q000627:therapeutic use; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy / Q000523:psychology*; D013921:Thrombocytopenia / Q000139:chemically induced; D014191:Tranylcypromine / Q000009:adverse effects* / Q000627:therapeutic use
D000931:Antidotes; D008996:Monoamine Oxidase Inhibitors; D014191:Tranylcypromine; D010830:Physostigmine