Category: Parkinsonism, Atypical: MSA
Objective: The aim of this study was to report fever and syndrome of inappropriate antidiuretic hormone secretion induced by duloxetine intake in patient with multiple system atrophy.
Background: Multiple system atrophy (MSA) is a neurodegenerative disease mainly involving extrapyramidal system, cerebellum and autonomic nervous system, while hypothalamus is affected with different degree. Duloxetine was prescribed for chronic pain as a dual inhibitor of 5-HT and norepinephrine reuptake, with fever or SIADH as rare side effects.
Method: Clinical observations and analysis of serum sodium and body temperature were used before and after duloxetine
Results: The use of duloxetine resulted in increased body temperature and decreased blood sodium in patient with multisystem atrophy, which gradually improved after withdrawal.
Conclusion: We report on this rare case. In addition to considering infectious, tumor and autoimmune diseases in MSA patients, drug factors cannot be ignored. For MSA patients with suspected hypothalamic involvement, when low blood sodium, laryngeal stridor and others occur, drugs that burden the hypothalamus should be used carefully, such as duloxetine.
References: 1. Samukawa, M., et al., Risks of inappropriate secretion of antidiuretic hormone in multiple system atrophy. Mov Disord, 2011. 26(14): p. 2572-3.
2. Fanciulli, A. and G.K. Wenning, Multiple-system atrophy. N Engl J Med, 2015. 372(3): p. 249-63.
3. Koga, S. and D.W. Dickson, Recent advances in neuropathology, biomarkers and therapeutic approach of multiple system atrophy. J Neurol Neurosurg Psychiatry, 2018. 89(2): p. 175-184.
4. Fanciulli, A., et al., Multiple system atrophy. Int Rev Neurobiol, 2019. 149: p. 137-192.
5. Bymaster, F.P., et al., Duloxetine (Cymbalta), a dual inhibitor of serotonin and norepinephrine reuptake. Bioorg Med Chem Lett, 2003. 13(24): p. 4477-80.
6. Gelener, P., et al., Serotonin syndrome due to duloxetine. Clin Neuropharmacol, 2011. 34(3): p. 127-8.
7. Knadler, M.P., et al., Duloxetine: clinical pharmacokinetics and drug interactions. Clin Pharmacokinet, 2011. 50(5): p. 281-94.
8. Citrome, L., Vortioxetine for major depressive disorder: An indirect comparison with duloxetine, escitalopram, levomilnacipran, sertraline, venlafaxine, and vilazodone, using number needed to treat, number needed to harm, and likelihood to be helped or harmed. J Affect Disord, 2016. 196: p. 225-33.
9. Arnold, L.M., et al., A double-blind, multicenter trial comparing duloxetine with placebo in the treatment of fibromyalgia patients with or without major depressive disorder. Arthritis Rheum, 2004. 50(9): p. 2974-84.
10. Boyle, J., et al., Randomized, placebo-controlled comparison of amitriptyline, duloxetine, and pregabalin in patients with chronic diabetic peripheral neuropathic pain: impact on pain, polysomnographic sleep, daytime functioning, and quality of life. Diabetes Care, 2012. 35(12): p. 2451-8.
11. Smith, E.M., et al., Effect of duloxetine on pain, function, and quality of life among patients with chemotherapy-induced painful peripheral neuropathy: a randomized clinical trial. Jama, 2013. 309(13): p. 1359-67.
12. Kelesidis, T. and I. Kelesidis, Unexplained high fever in an elderly patient treated with clonidine, duloxetine, and atorvastatin. Clin Ther, 2009. 31(12): p. 2894-9.
13. Ananias, J. and S. Irarrazaval, Is duloxetine an alternative in the treatment of osteoarthritis? Medwave, 2017. 17(8): p. e7063.
14. Hu, D. and S. Wurster, Hyponatremia Induced by Duloxetine: A Case Report. Consult Pharm, 2018. 33(8): p. 446-449.
15. Lipp, A., et al., Prospective differentiation of multiple system atrophy from Parkinson disease, with and without autonomic failure. Arch Neurol, 2009. 66(6): p. 742-50.
16. Iodice, V., et al., Autopsy confirmed multiple system atrophy cases: Mayo experience and role of autonomic function tests. J Neurol Neurosurg Psychiatry, 2012. 83(4): p. 453-9.
17. Coon, E.A., et al., Purple hands in multiple system atrophy: Global anhidrosis with preserved acral sweating. Neurology, 2016. 86(24): p. 2314.
To cite this abstract in AMA style:
J. Shi, L. Liu, J. Lin, M. Zhang, H. Liu, L. Xie. Fever and syndrome of inappropriate antidiuretic hormone secretion induced by duloxetine intake in patient with multiple system atrophy [abstract]. Mov Disord. 2022; 37 (suppl 2). https://www.mdsabstracts.org/abstract/fever-and-syndrome-of-inappropriate-antidiuretic-hormone-secretion-induced-by-duloxetine-intake-in-patient-with-multiple-system-atrophy/. Accessed September 7, 2024.« Back to 2022 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/fever-and-syndrome-of-inappropriate-antidiuretic-hormone-secretion-induced-by-duloxetine-intake-in-patient-with-multiple-system-atrophy/