Diltiazem-induced psychosis and a possible diltiazem-lithium interaction
Article Abstract:
Calcium channel blockers have become popular for the treatment of hypertension (high blood pressure) and exertional angina (chest pain brought on by exercise). The more common side effects result from the action of the drug and are predictable; however, there are adverse reactions related to the central nervous system that are unpredictable and often unrecognized. Nifedipine has caused acute psychosis, and verapamil has caused acute delirium. Diltiazem, which otherwise causes few side effects, has caused restlessness and agitation (akathisia) and acute psychosis. A case is reported of a 66-year-old woman with bipolar affective disorder (manic-depression) who was taking lithium carbonate to control manic behavior, and nitroglycerin, estrogen, and levothyroxine sodium. She was put on diltiazem to control high blood pressure, and a few days later she became confused, forgetful, and depressed. A week after she began diltiazem she was admitted to psychiatric service. She was disheveled and knew her name, but not where she was, and she believed she had just gone through the San Francisco earthquake. Blood chemistry and results of other laboratory tests were normal. Diltiazem was discontinued, and she returned to normal within one week. The symptoms were not related to her manic-depressive disorder, but were those of lithium poisoning. Both diltiazem and verapamil have been reported to cause synergistic effects with lithium, and the side effects occurred even though blood lithium levels remained within the normal range. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Archives of Internal Medicine
Subject: Health
ISSN: 0003-9926
Year: 1991
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Nurse-led asthma clinic in an Asian community
Article Abstract:
The Manningham Airways Project set up in 1994 by the then Bradford Family Health Services Authority has been successful in improving awareness and control of asthma within the Asian community. The clinic operated by providing 30-minute appointments, with a patient seeing the same nurse whenever possible. Appointments covered practical issues such as peak-flow monitoring and inhaler technique, but also focused heavily on education. This educational aspect was tailored to the cultural background of patients: for example Hindus and Sikhs cannot use products containing gelatine.
Publication Name: Nursing Times
Subject: Health
ISSN: 0954-7762
Year: 1997
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