TAILIEUCHUNG - Pisa syndrome associated with mirtazapine: A case report

Mirtazapine is a noradrenergic and specific serotonergic antidepressant; its pharmacological profile indicates a low risk for dopaminergic adverse effects. To date, there has been only a single case report of Pisa syndrome associated with mirtazapine. | Yamada et al. BMC Pharmacology and Toxicology 2018 19 82 https s40360-018-0272-8 BMC Pharmacology and Toxicology CASE REPORT Open Access Pisa syndrome associated with mirtazapine a case report W1 1 2 11 1 1 vamaaa Harumasa laKano MaKi vamaaa NaoKo sataKe Naotsugu Hirabayashi Miisuiosni OKazaKi and KazuyuKi NaKagome3 Abstract Background Mirtazapine is a noradrenergic and specific serotonergic antidepressant its pharmacological profile indicates a low risK for dopaminergic adverse effects. To date there has been only a single case report of Pisa syndrome associated with mirtazapine. Case presentation The authors report a case involving a 79-year-old woman with bipolar disorder in whom Pisa syndrome occurred after introduction of mirtazapine and completely disappeared 3 days after suspension of the drug. Conclusions Aspects of this particular case suggest that Pisa syndrome is a possible side effect of Mirtazapine. Keywords Mirtazapine Side-effects Dystonia Pisa syndrome Bipolar disorder Background Mirtazapine MTZ is a noradrenergic and specific serotonergic antidepressant which is also classified as a tetracyclic antidepressant 1 . Because MTZ does not strongly block the dopamine D1 D2 receptor there are few reports describing parkinsonism caused by the drug. In the three clinical trials undertaken in Japan the incidence of dyskinesia was but there was no report in terms of parkinsonism or dystonia 2 . In the English literature there are only two case reports describing dystonia with MTZ use with one involving Pisa syndrome 3 4 both of which are cases of major depression. Pisa syndrome is a type of dystonia originally described by Ekbom et al. 1972 5 which produces abnormally sustained posture with a lateral inclination of the trunk and a degree of backward axial rotation. Drug-induced Pisa syndrome is commonly observed in patients undergoing long-term antipsychotic treatment. However it has also been repor-ted albeit less frequently in patients

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