Case: Hypertensive Disaster Following Use of Armodafinil + MAOI

Steve Duffy, Digital Content material Editor August 15, 2018 Within the ED, the affected person was discovered to be hypertensive with a blood str...

August 15, 2018

In the ED, the patient was found to be hypertensive with a blood pressure of 186/120 mmHg

Within the ED, the affected person was discovered to be hypertensive with a blood strain of 186/120 mmHg

A report printed within the Journal of the Neurological Sciences particulars a case of acute hypertensive disaster and extreme headache following concurrent remedy with armodafinil and tranylcypromine.

Whereas the labeling for armodafinil and modafinil advises warning when prescribing these wakefulness promoters with monoamine oxidase inhibitors (MAOIs) comparable to tranylcypromine, little knowledge exist to substantiate the potential dangers related to concurrent use. This case concerned a 36-year-old feminine with bipolar dysfunction who offered to the emergency division (ED) with blurry imaginative and prescient, neck stiffness and the “worst headache of (her) life” after taking armodafinil with tranylcypromine.

Her remedy historical past indicated that she had been taking tranylcypromine (20mg twice every day) with armodafinil (250mg every day) for two months, along with brexpiprazole zero.5mg every day. The morning of her admittance to the ED, the tranylcypromine dose was adjusted from 20mg twice every day to 40mg within the morning.

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Within the ED, the affected person was discovered to be hypertensive with a blood strain (BP) of 186/120 mmHg. She was handled with intravenous morphine, which diminished the severity of the headache, and her BP decreased over the course of the day. She was admitted for statement throughout which her drugs had been discontinued; three days later, her signs had subsided.

To analyze the outcomes of comparable circumstances, the authors carried out a literature evaluation and recognized 6 different circumstances the place sufferers had been handled with modafinil and an MAOI; 5 of those sufferers had no adversarial occasions, whereas 1 (Vytopil et al. 2007) developed acute chorea and hyperthermia three days after modafinil was added to tranylcypromine. Relating to brexpiprazole, the authors famous latest research which confirmed that the usage of atypical antipsychotics with MAOIs or armodafinil gave the impression to be secure, nonetheless, they added “it’s doable that brexpiprazole exacerbated or contributed to the underlying signs.”

Primarily based on the findings of this case and others within the literature, the authors concluded, “We […] advocate that physicians train warning if utilizing these lessons of medication collectively.”

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