Serotonin toxicity comprises altered mental state agitation, excitement, confusion , neuromuscular hyperactivity tremor, clonus, myoclonus, hyper-reflexia and autonomic hyperactivity and occurs on a spectrum. Severe cases, termed serotonin syndrome, usually follow the co-prescription of drugs that increase serotonergic transmission by different pathways, for example a monoamine oxidase inhibitor MAOI and a selective serotonin reuptake inhibitor SSRI. Most antipsychotics and antidepressants lower the seizure threshold and can cause seizures; the risk is greater with clozapine than with other atypical antipsychotics and greater with tricyclic antidepressants TCAs than with SSRIs.
In randomised controlled trials in elderly patients with dementia atypical antipsychotics are associated with a higher risk of stroke and death than placebo. Drug-induced neurologic conditions may result from single-agent drug regimens, but they are more likely to occur when multiple agents that confer risk are administered concomitantly. Educating patients about these risks and remaining vigilant in clinical investigations of unusual adverse effects are key elements to increasing the safety of drug management.
Along with awareness of the improved health outcomes resulting from drug therapy comes the recognition that drug therapy may also contribute to the emergence of new disorders. Mindful consideration of the possibility of drug-induced neurologic symptoms must be part of any ongoing evaluation of the evolving body of evidence obtained through clinical case reports. The emergence of new neurologic side effects of drugs heightens the challenges prescribers face when considering drug therapy.
These side effects can result in potential misdiagnoses, including false psychiatric diagnoses, in the case of some drugs. Unexpected and unpredictable drug interactions can result in a confusing range of symptoms that may be identified as a new medical condition. Pharmacists may not routinely anticipate or recognize these new conditions caused by common drug agents. Changes in the central nervous system brain, spinal cord or peripheral nerves can cause a wide variety of symptoms, including loss of coordination and muscle strength, numbness, loss of consciousness, seizures, and paralysis TABLE 1.
Often, it is difficult to determine whether a neurologic condition is caused by a drug. One of the more difficult aspects of such an investigation is ensuring the specificity of the event related to the drug by ruling out other potential causes of the disorder.
Limits in premarketing data make postmarketing surveillance essential to identifying new neurologic side effects of drugs. Cerebellar syndrome is a consequence of the disruption of normal function of the brain region that is responsible for coordination and balance.
Drug-induced cerebellar syndrome can be caused by a number of drugs, including phenytoin, lithium, carbamazepine, certain chemotherapeutic agents, and aminoglycoside antibiotics. In addition to loss of coordination, some patients may experience dysarthria and nystagmus. Many cases are reversible; however, permanent cerebellar syndrome can result, especially with administration of high doses and concurrent use of agents conferring risk, such as lithium plus antipsychotics.
Although its incidence is rare and based on case reports, cerebellar syndrome is included in current drug-drug interaction databases, with warnings to clinicians to use appropriate caution. While hormone replacement therapy is no longer routinely prescribed for menopausal women, the risk of neurologic side effects must be considered in women taking injectable hormone therapies or oral contraceptives.
When agents that can have cerebrovascular effects are clinically indicated, the pharmacist must assist the patient in managing any modifiable risk factors, such as hypertension, diabetes, and hypercholesterolemia. Dietary changes, increased physical activity, and smoking cessation are critical nonpharmacologic interventions.
There have been reports of cerebrovascular and other vascular effects from antipsychotic agents. A significantly increased incidence of transient ischemic attack, cerebral ischemia, unspecified cerebrovascular disorders, and stroke has been reported versus placebo in patients older than 73 years who have dementia-related psychosis.
Individual stroke risk factors such as smoking, hypertension, and diabetes increase the risk of this adverse neurologic event. Elderly patients with dementia-related psychosis being treated with antipsychotics are at increased risk for death secondary to stroke and other cerebrovascular complications. Delirium can be a neurologic side effect of drugs, especially in although not limited to elderly patients.
Delirium is characteristically acute in onset and precipitates fluctuations in cognition, mood, attention, and arousal. Delirium can be reversed when the underlying causative agent is identified and removed.
Increased awareness of the drugs that contribute to cognitive impairment is necessary, particularly with elderly patients. Anticholinergic agents are among the classes with the highest risk of precipitating confusion and cognitive impairment, and the severity increases when multiple agents with confounding risks are used together.
Research indicates that the total cumulative anticholinergic effect can better predict the development of delirium than the specific drug itself. Cognitive toxicity can develop quickly, especially when the patient is not educated about this potential drug-induced effect and worsens the risk by self-medicating with OTC drugs that increase the overall burden. The disorder does not usually cause life-threatening complications, but it can be uncomfortable or disabling.
Call your provider if you have a loss of sensation or movement of any area of the body while taking any medicine. Your provider will closely monitor your treatment with any drug that may cause neuropathy. The goal is to keep the proper blood level of the drug needed to control the disease and its symptoms while preventing the drug from reaching toxic levels. Drug-induced peripheral neuropathy, a narrative review.
Curr Clin Pharmacol. PMID: pubmed. Katirji B. Disorders of peripheral nerves. Philadelphia, PA: Elsevier; chap Mastaglia FL. Drug-induced disorders of the nervous system. With time, damage to the nervous system is expected to reverse itself in most people.
Fortunately, CNS repair is possible. Whether treating CNS injury due to substance abuse or neurological disease, it is possible to repair damage caused to the CNS. These strategies have been developed to repair damage to the nervous system:. The above strategies focus on promoting neural cell growth so healthy neural connections can be reestablished and neural networks can function properly once again.
New pathways are formed as healthy, undamaged nerve endings grow and connect with other healthy nerve cells. If you have a history of drug abuse that has made notable impacts on your nervous system, you will benefit from treatment to address the damage. Drug abuse is difficult to overcome on your own, but it is possible with the support of a proper recovery program.
Decades of research on addiction and recovery have contributed to the development of evidenced-based treatment programs that help people quit using harmful substances and recover from the damage their drug abuse caused to their bodies and minds.
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NALGAP is The Association of Lesbian, Gay, Bisexual, Transgender Addiction Professionals and Their Allies is a membership organization founded in and dedicated to the prevention and treatment of alcoholism, substance abuse, and other addictions in lesbian, gay, bisexual, transgender, queer communities. NAADAC , the Association for Addiction Professionals, represents the professional interests of more than , addiction counselors, educators and other addiction-focused health care professionals in the United States, Canada and abroad.
Drug abuse greatly affects one of the most vital systems in your body: the nervous system. What Is the Nervous System? The nervous system performs these additional functions: Controlling heart rate Releasing hormones Regulating digestion Protecting neurons and neurotransmitters Influencing behavior and emotions Drugs That Affect the Nervous System Both recreational drugs and those prescribed for medical reasons impact the nervous system. Short-Term Effects of Drug Abuse on the Nervous System The effects of drugs on the nervous system vary from person to person and depending on which drugs are being abused.
Risk of Overdose All drugs pose a risk of overdose when abused for recreational purposes.
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