title: Pisa syndrome due to donepezil: pharmacokinetic interactions to blame?
abstract: We report a case of Pisa syndrome (PS) due to the acetylcholinesterase inhibitor donepezil which may have been precipitated by pharmacokinetic interactions with commonly used medications. PS is defined as a reversible lateral bending of the trunk with a tendency to lean to one side. This is a rare but very distressing complication with this commonly used medication which was not initially recognised, leading to increasing disability for the patient and significant carer stress. Cessation of donepezil and modulation of potential interacting medications resulted in complete resolution.
authors.affiliation: Elderly Care Unit, Belfast Health and Social Care trust, 51 Lisburn Road, Belfast BT9 7AB, UK.
authors.forename: David
authors.initials: D
authors.lastname: Pollock
authors.affiliation: Centre for Public Health, Institute of Clinical Sciences, Queens University Belfast, Block B, Grosvenor Road, Belfast BT12 6BJ, UK.
authors.forename: Emma
authors.initials: E
authors.lastname: Cunningham
authors.affiliation: Centre for Public Health, Institute of Clinical Sciences, Queens University Belfast, Block B, Grosvenor Road, Belfast BT12 6BJ, UK.
authors.forename: Bernadette
authors.initials: B
authors.lastname: McGuinness
authors.affiliation: Centre for Public Health, Institute of Clinical Sciences, Queens University Belfast, Block B, Grosvenor Road, Belfast BT12 6BJ, UK.
authors.forename: Anthony Peter
authors.initials: AP
authors.lastname: Passmore
mesh_terms: D000369:Aged, 80 and over; D002800:Cholinesterase Inhibitors / Q000009:adverse effects* / Q000493:pharmacokinetics; D000077265:Donepezil; D004347:Drug Interactions; D020821:Dystonic Disorders / Q000139:chemically induced* / Q000175:diagnosis / Q000503:physiopathology; D006801:Humans; D007189:Indans / Q000009:adverse effects* / Q000493:pharmacokinetics; D008297:Male; D009853:Omeprazole / Q000009:adverse effects / Q000493:pharmacokinetics; D010880:Piperidines / Q000009:adverse effects* / Q000493:pharmacokinetics; D019338:Polypharmacy; D004856:Postural Balance / Q000187:drug effects*; D054328:Proton Pump Inhibitors / Q000009:adverse effects / Q000493:pharmacokinetics; D012307:Risk Factors
chemical_list: D002800:Cholinesterase Inhibitors; D007189:Indans; D010880:Piperidines; D054328:Proton Pump Inhibitors; D000077265:Donepezil; D009853:Omeprazole
keywords: Alzheimer's disease; Pisa syndrome; donepezil; older people