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Abstract

A case of urinary retention emerging after fluoxetine (20 mg/day) addition to low risperidone doses (2 mg/day) is presented. Severe extrapyramidal side-effects (EPS) also occurred after fluoxetine–risperidone combination. Several possibilities, based on the pharmacodynamic and pharmacokinetic properties of risperidone and fluoxetine, which merit consideration in an attempt to explain our patient's side-effects, are discussed. Extrapyramidal side-effects can be due to an increase of the plasma concentration of risperidone and/or the intrinsic propensity of fluoxetine to produce EPS. Urinary retention may be the consequence of a central serotoninergic mechanism in, or without, combination central D2 blockade.

Keywords

extrapyramidalside-effects fluoxetine risperidone urinaryretention

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References

Anderson K-E (2000) Treatment of overactive bladder: drug mechanisms. Urology 55(Suppl. 5A): 51–57

Arya D K (1994) Extrapyramidal symptoms with selective serotonin reuptake inhibitors. Br J Psychiatry 165: 728–733

Balant-Giorgia A E , Gex-Fabry M , Genet C , Balant L P (1999) Therapeutic drug monitoring of risperidone using a new, rapid HPLC method: reappraisal of interindividual variability factors. Ther Drug Monit 21: 105–115

Barnes T R E , McPhillips M A (1999) Critical analysis and comparison of the side-effect and safety profiles of the new antipsychotics. Br J Psychiatry 174(Suppl. 38): 34–43

Collaborative Working Group on Clinical Trial Evaluations (1998) Adverse effects of the atypical antipsychotics. J Clin Psychiatry 59(Suppl. 12): 7–22

Coulter D M , Pillans P I (1995) Fluoxetine and extrapyramidal side effects. Am J Psychiatry 152: 122–125

Greenblatt D J , von Moltke L L , Schmider J , Harmatz J S , Shader R I (1996) Inhibition of human cytochrome P450–3A isoforms by fluoxetine and norfluoxetine: in vitro and in vivo studies. J Clin Pharmacol 36: 792–798

He H , Richardson J S (1995) A pharmacological, pharmacokinetic and clinical overview of risperidone, a new antipsychotic that blocs serotonin 5HT2 and dopamine D2 receptors. Int Clin Psychopharmacol 10: 19–30

Hiemke C , Härtter S (2000) Pharmacokinetics of selective serotonin reuptake inhibitors. Pharmacol Ther 85: 11–28

10.

Leo R J (1996) Movement disorders associated with the serotonin selective inhibitors. J Clin Psychiatry 57: 449–454

11.

Odou P , Levron J C , Luyckx M , Brunet C , Robert H (2000) Risperidone drug monitoring: a useful clinical tool? Clin Drug Invest 19: 283–292

12.

Scordo M G , Spina E , Facciola G , Avenoso A , Johansson I , Dahl M-L (1999) Cythochrome P450 2D6 genotype and steady state plasma levels of risperidone and 9-hydroxyrisperidone. Psychopharmacology 147: 300–305

13.

Simpson G M , Angus J W S (1970) A rating scale for extrapyramidal side effects. Acta Psychiatr Scand 212(Suppl.): 11–19

14.

Stahl S M (1996) Essential psychopharmacology. Cambridge University Press, New York

15.

Tollefson G D , Rosenbaum J F (1998) Selective serotonin reuptake inhibitors. In Schatzberg A F , Nemeroff C B (eds), Textbook of psychopharmacology, 2nd edn, pp. 219–237. American Psychiatric Press, Washington DC

16.

Yoshimura N , Mizuta E , Kuno S , Sasa M , Yoshida O (1993) The dopamine D1 receptor agonist SKF 38393 suppresses detrusor hyperreflexia in the monkey with parkinsonism induced by 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP). Neuropharmacology 32: 315–321

17.

Zorn B H , Montgomery H , Pieper K , Gray M , Steers W D (1999) Urinary incontinence and depression. J Urol 162: 82–84

Urinary retention caused after fluoxetine–risperidone combination

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