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- Title
Clinical difficulties in the treatment of restless legs syndrome: it is the dose that makes poison.
- Authors
Petrykiv, S.; Arts, M.; De Jonge, L.
- Abstract
Introduction: Unjustified high dosages of medicaments represent an unmet need in modern psychiatry. Tidal medication review of hospitalised geriatric patients is an essential step of the disease management, as illustrated by current case rapport. Objectives: To provide a case rapport on geriatric patient with iatrogenic damage due to ultra high dosage of ropinirole. Methods: Authors of current paper discuss pharmacodynamic particularities of psychopharmaca - and their reasonable choice - in context to RLS. Results: A 72 y.o. patient, known with chronic depressive symptoms and RLS, increased the dose of ropinirol up to 12 mg/day, what went unnoticed by health providers. Two moths later he has been admitted to the psychiatric ward with major depression symptoms, suicidal plans, insomnia and profound edema of his both lower legs. All relevant somatic causes were excluded first. Right after a dose reduction of ropinirol down to 6 mg/day, we achieved a significant decrease of edema, improvement of mood and resolving of suicidal ideations. No antidepressant was added. His sleeping pattern was normalised by adding of trazodone 50 mg/day. In four weeks the patient was discharged from the hospital, and trazodon was subsequently stopped. Conclusions: Solely by reducing the dose of ropinirole we achieved a significant improvement of all of the symptoms of this patient. Therefore, we advocate for carefully assessment of the dose of every drug used; avoidance of polyfarmacy by any means and for keeping in consideration that the majority of psychofarmaca leads to deterioration of RLS symptoms through modulation of dopamine pathways.
- Subjects
RESTLESS legs syndrome; POISONS; HOSPITAL admission &; discharge; POISONING; MEDICATION reconciliation
- Publication
European Psychiatry, 2020, Vol 63, pS116
- ISSN
0924-9338
- Publication type
Article