Faculty Bibliography

Among the most common side effects associated with modafinil in premarketing trials were headache, nausea, anxiety, and insomnia. Postmarketing, modafinil has been associated with mania and psychosis. Now comes a report of modafinil-induced premature ventricular contractions (PVCs). N. Oskooilar (see record 2005-12096-036) described the case of a 54-year-old male who presented with combat fatigue and impaired concentration. He was administered modafinil 100 mg every morning, which was titrated to 200 mg every morning then subsequently administered in divided doses. Modafinil worked well to offset his complaints; however, after 2.5 months, he developed PVCs. Given the increasingly prevalent use of modafinil, clinicians need to be aware of the possibility of precipitating PVCs, including in those with no history of cardiac disease.

Presents a case report in which the antibiotic meropenem reduced serum levels of valproic acid, resulting in the precipitation of acute seizures. A 21-year-old woman with no significant past medical history presented to the emergency service with a new-onset, generalized, tonic-clonic seizure. Upon admission she experienced three episodes of generalized tonicclonic seizures, which remitted with administration of intravenous (IV) diazepam 10 mg. At this point, phenytoin IV 100 mg TID was initiated. Valproic acid 1,000 mg as a continuous IV infusion over 24 hours was introduced. The patient gradually became obtunded and required intubation for airway protection. The serum concentration of valproic acid was 52.5 mu g/mL. On day 13, meropenem IV 1,000 mg TID was initiated. On day 15, when the patient was afebrile, numerous myoclonic episodes occurred involving the arms and face. At the time, the serum valproic acid concentration was 42 mu g/mL. Despite the increased dosage, the plasma valproic acid level fell to 7 mu g/mL. After suspension of meropenem the patient became asymptomatic. The temporal sequence of events is consistent with a pharmacokinetic interaction, in which administration of meropenem resulted in reduced serum levels of valproic acid.

Presents a report of a patient who, after having taken oral risperidone without any side effects, subsequently developed a severe allergic reaction to the depot formulation. A 46-year-old man with chronic schizophrenia was hospitalized with paranoia and disorganized thinking after using cocaine and having stopped his ziprasidone. Prior to this, he had been taking several different antipsychotics, including risperidone at bedtime. The patient received depot risperidone intermuscular. Within 4-6 hours of injection, the patient developed urticaria with an erythematous, raised pruritic rash covering large areas of his body. He was treated with oral diphenhydramine, 50 mg TID, and topical hydrocortisone cream but the rash worsened and the patient developed faint expiratory wheezing bilaterally. He was given dexamethasone IM 4 mg. Over the next 48 hours, the rash began to improve.

Presents an open-label pilot study which suggests that, in selected cases of treatment-resistant depression (TRD), ropinirole augmentation of antidepressants is effective and relatively well tolerated. The study was a 16-week, prospective, open trial conducted at the Department of Psychiatry of the University of Pisa among patients with TRD. Adult patients 18-75 years of age diagnosed with major depressive disorder were eligible for the study. Ten subjects with TRD were consecutively enrolled in the study. The mean age was 51 years, and 7 of the 10 subjects were women. The median duration of stable or unmodified antidepressant treatment prior to ropinirole augmentation was 7 weeks. Ropinirole was added to the current treatment with an endpoint mean dosage of 1.33 mg/day.