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Abstract

OBJECTIVE:

To report a case of trimethoprim/sulfamethoxazole (TMP/SMX)-induced tremor responsive to a reduction in dosage.

CASE SUMMARY:

A 55-year-old white man with AIDS and Pneumocystis carinii pneumonia (PCP) developed a tremor after receiving 5 days of therapy with TMP/SMX 19.4 mg/kg/d (TMP). The tremor resolved completely 3 days after a dosage reduction to TMP/SMX 15.1 mg/kg/d.

DISCUSSION:

Central nervous system adverse reactions to TMP/SMX have been reported in both the AIDS and non-AIDS populations. To our knowledge, this is the first reported case of TMP/SMX-induced tremor responsive to a reduction in dosage. Pharmacokinetic and clinical data suggest a concentration-dependent etiology for various adverse effects, including tremor. The mechanism of the tremor is unknown; however, toxic metabolites of SMX and disruptions of biogenic amine neurotransmission by TMP have been hypothesized.

CONCLUSIONS:

TMP/SMX remains the drug of first choice for treating PCP, but it is clearly not well tolerated by patients with AIDS. Concentration-dependent toxicities such as tremor may lead to premature discontinuation of proven, effective TMP/SMX therapy. Using the lower end of the recommended dosing range for TMP/SMX (TMP 15 mg/kg/d) may reduce the incidence of these toxicities while still achieving acceptable TMP concentrations and antimicrobial efficacy.

OBJETIVO:

Informar el caso de una reacción de temblores asociados al uso de trimetoprim/sulfametoxazol (TMP/SMX) que respondió a una reducción en dosis.

RESUMEN DEL CASO:

Un hombre de 55 años de edad con diagnóstico de SIDA desarrolló temblores tras el uso por 5 días de TMP/SMX para el tratamiento de una pulmonia por Pneumocystis carinii (PCP). El paciente estaba recibiendo una dosis de 19.4 mg/kg/día del componente de trimetoprim (TMP). Los temblores desaparecieron completamente 3 días luego de que la dosis TMP/SMX fuera reducida a 15.1 mg/kg/día.

DISCUSIÓN:

Las reacciones adversas a TMP/SMX se han reportado tanto en pacientes con SIDA como en pacientes que no padecen de esta condición. Según entienden los autores, este es el primer informe de temblores inducidos por TMP/SMX que responde a una reducción en dosis. Los datos farmacocinéticos y clínicos sugieren una etiología relacionada a la dosis para varios de los efectos adversos, incluyendo los temblores. El mecanismo mediante el cual ocurren los temblores no es conocido, sin embargo se ha sugerido que metabolitos tóxicos de SMX y alteraciones en la neurotransmisión de aminas pueden ser factores contribuyentes.

CONCLUSIONES:

TMP/SMX continúa siendo el agente de selección para el tratamiento de PCP, pero es claramente no muy bien tolerado en pacientes que padecen del SIDA. Reacciones tóxicas que pueden estar relacionadas a la concentración del fármaco, como por ejemplo, los temblores, pueden llevar a la descontinuación prematura del tratamiento con TMP/SMX. El utilizar la dosis más baja dentro del rango de dosis recomendado (15 mg/kg/día de TMP) podría reducir la incidencia de toxicidad, alcanzando aún concentraciones de TMP aceptables que mantienen la efectividad antimicrobial.

OBJECTIF:

Signaler un cas de tremblement associé au TMP/SMX qui a répondu à une diminution de la dose.

RÉSUMÉ DU CAS:

Un homme âgé de 55 ans souffrant du SIDA a développé un tremblement à la suite d'un traitement de 5 jours pour une pneumonie à Pneumocystis carinii (PPC) à l'aide de TMP/SMX à la dose de 19.4 mg/kg/jour TMP. Le tremblement est disparu complètement 3 jours après une diminution de la dose de TMP/SMX à 15.1 mg/kg/jour.

DISCUSSION:

Des effets indésirables au niveau du système nerveux central associés au TMP/SMX ont déjà été signalés tant chez la population sidéenne que non-sidéenne. À la connaissance des auteurs, il s'agit du premier cas signalé de tremblement induit par le TMP/SMX qui répond à une diminution de la dose. Des données pharmacinétiques et cliniques suggèrent un lien entre plusieurs effets indésirables, y compris les tremblements, et la concentration du médicament. Le mécanisme expliquant le tremblement n'est pas connu, mais on a émis l'hypothèse de l'existence de métabolites toxiques du SMX ou encore le bris de la neurotransmission des amines biogènes par le TMP.

CONCLUSIONS:

Le TMP/SMX demeure le médicament de premier choix dans le traitement de la PPC, mais il est définitivement mal toléré chez les patients sidéens. Des toxicités reliées à la dose, tel le tremblement, peut conduire à un arrêt prématuré du TMP/SMX, une thérapie prouvée efficace. Utiliser le TMP/SMX à la dose minimale efficace (15 mg/kg/jour de TMP) peut diminuer l'incidence de ces toxicités tout en assurant des taux acceptables de TMP et une efficacité antimicrobienne.

Keywords

trimethoprim/sulfamethoxazole tremor human immunodeficiency virus

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Trimethoprim/Sulfamethoxazole-Induced Tremor in a Patient with AIDS

Abstract

OBJECTIVE:

CASE SUMMARY:

DISCUSSION:

CONCLUSIONS:

OBJETIVO:

RESUMEN DEL CASO:

DISCUSIÓN:

CONCLUSIONES:

OBJECTIF:

RÉSUMÉ DU CAS:

DISCUSSION:

CONCLUSIONS:

Keywords

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References