Drug-induced dyskinesia when taking Fluvoxamine

Drug-induced movement disorders (DIMD) are a significant problem in clinical practice, especially in the context of the use of psychotropic drugs. These disorders can significantly worsen the quality of life of patients and lead to additional difficulties in the treatment of the underlying disease. In recent years, there has been a growing interest in this topic, which is associated with an increase in the number of antidepressants and antipsychotics prescribed and an increasing awareness of possible side effects. Fluvoxamine is one of the most common selective serotonin reuptake inhibitor, and its use is associated with the risk of developing adverse phenomena such as dystonia and tremor. This emphasizes the need for careful monitoring of the patient's condition and assessment of the risk/benefit ratio. The relevance of the problem is also reinforced by the fact that DIMD can manifest differently in different patients, requiring an individualized approach in each case. In this regard, it is important to continue research in this area in order to better understand the mechanisms of occurrence and methods of treatment of DIMD. We describe a clinical case of the development of dose-dependent DIMD in a patient with an obsessive-compulsive disorder who took Fluvoxamin at a dose of 225 mg/day. As a treatment of acute motor disorders caused by Fluvoxamin, the use of amantadine sulfate (PK-Merz) is being considered, which has a complex effect on neurotransmitter systems and has been shown to be effective in stopping this undesirable phenomenon. It should be noted that Fluvoxamin may have a beneficial effect in tardive dyskinesia and chorea, but the mechanisms of this effect are still poorly understood.

1. Bakheit A. The syndrome of motor restlessness – a treatable but under-recognised disorder. Postgrad Med J. 1997 Sep;73(863):529-30. doi: 10.1136/pgmj.73.863.529

2. Casey DE. Tardive dyskinesia. West J Med. 1990 Nov;153(5):535-41.

3. Mena MA, de Yebenes JG. Drug-induced parkinsonism. Expert Opin Drug Saf. 2006 Nov;5(6):759-71. doi: 10.1517/14740338.5.6.759

4. Orti-Pareja M, Jimenez-Jimenez FJ, Vazquez A, et al. Drug-induced tardive syndromes. Parkinsonism Relat Disord. 1999 Apr;5(1-2):59-65. doi: 10.1016/s1353-8020(99)00015-2

5. Van Harten PN, Hoek HW, Kahn RS. Acute dystonia induced by drug treatment. BMJ. 1999 Sep 4;319(7210):623-6. doi: 10.1136/bmj.319.7210.623

6. Lustig A. Drug-Induced Movement Disorders. Perspect Neurophysiol Neurogen Speech Lang Disord. 2015;25(2):70. doi: 10.1044/nnsld25.2.70

7. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Washington, DC: American Psychiatric Publishing; 1994. 886 p. ISBN 978-0-89042-061-4. ISBN 978-0-89042-062-1. ISBN 0-89042-061-0. Available at: https://www.appi.org/products/dsm

8. International Statistical Classification of Diseases and Related Health Problems (ICD-10). Available at: https://icd.who.int/browse10/2019/en

9. Kantor ED, Rehm CD, Haas JS, et al. Trends in Prescription Drug Use Among Adults in the United States From 1999-2012. JAMA. 2015 Nov 3;314(17):1818-31. doi: 10.1001/jama.2015.13766

10. Reid S, Barbui C. Long term treatment of depression with selective serotonin reuptake inhibitors and newer antidepressants. BMJ. 2010 Mar 26;340:c1468. doi: 10.1136/bmj.c1468

11. Revet A, Montastruc F, Raynaud JP, et al. Trends and Patterns of Antidepressant Use in French Children and Adolescents From 2009 to 2016: A Population-Based Study in the French Health Insurance Database. J Clin Psychopharmacol. 2018 Aug;38(4):327-35. doi: 10.1097/JCP.0000000000000891

12. Dodd S, Mitchell PB, Bauer M, et al. Monitoring for antidepressant-associated adverse events in the treatment of patients with major depressive disorder: An international consensus statement. World J Biol Psychiatry. 2018 Aug;19(5):330-48. doi: 10.1080/15622975.2017.1379609. Epub 2017 Oct 6. Erratum in: World J Biol Psychiatry. 2018 Aug;19(5):i. doi: 10.1080/15622975.2018.1427669

13. Available at: https://www.rlsnet.ru/activesubstance/fluvoksamin-1036

14. Revet A, Montastruc F, Roussin A, et al. Antidepressants and movement disorders: a postmarketing study in the world pharmacovigilance database. BMC Psychiatry. 2020 Jun 16;20(1):308. doi: 10.1186/s12888-020-02711-z

15. Gupta D, Bhardwaj A, Prakash R, Jose N. Fluvoxamine-induced tics: A rare phenomenon. Arch Med Health Sci. 2022;10:274-6. doi: 10.4103/amhs.amhs_207_22

16. Wils V. Extrapyramidal symptoms in a patient treated with fluvoxamine. J Neurol Neurosurg Psychiatry. 1992 Apr;55(4):330-1. doi: 10.1136/jnnp.55.4.330

17. Meco G, Bonifati V, Fabrizio E, Vanacore N. Worsening of parkinsonism with fluvoxamine – two cases. Hum Psychopharmacol Clin Exper. 1994;9(6):439-41. doi: 10.1002/HUP.470090607

18. Caroff SN, Jain R, Morley JF. Revisiting amantadine as a treatment for drug-induced movement disorders. Ann Clin Psychiatry. 2020 Aug;32(3):198-208.

19. Rascol O, Fabbri M, Poewe W. Amantadine in the treatment of Parkinson's disease and other movement disorders. Lancet Neurol. 2021 Dec;20(12):1048-56. doi: 10.1016/S1474-4422(21)00249-0. Epub 2021 Oct 19.

20. Katunina EA. Amantadine in the treatment of Parkinson's disease. New opportunities in the context of COVID-19. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova = S.S. Korsakov Journal of Neurology and Psychiatry. 2021;121(4):101-6. doi: 10.17116/jnevro2021121041101 (In Russ.).

21. Caley CF. Extrapyramidal reactions and the selective serotonin-reuptake inhibitors. Ann Pharmacother. 1997 Dec;31(12):1481-9. doi: 10.1177/106002809703101208

22. Jimenez-Jimenez F, Molina J. Extrapyramidal Symptoms Associated with Selective Serotonin Reuptake Inhibitors. CNS Drugs. 2000;14:367-79. doi: 10.2165/00023210-200014050-00004

23. Artieda J, Garcia De Casasola MC, Pastor MA, et al. Bases fisiopatologicas de la distonia [The pathophysiological basis of dystonia]. Rev Neurol. 2001 Mar 16-31;32(6):549-58 (In Span.).

24. Palop V, Jimenez MJ, Catalan C, Martinez-Mir I. Acute dystonia associated with fluvoxamine-metoclopramide. Ann Pharmacother. 1999 Mar;33(3):382. doi: 10.1345/aph.18205

25. Albayrak Y, Hashimoto K. Beneficial effects of the sigma-1 agonist fluvoxamine for tardive dyskinesia in patients with postpsychotic depressive disorder of schizophrenia: report of 5 cases. Prim Care Companion CNS Disord. 2012;14(6):PCC.12br01401. doi: 10.4088/PCC.12br01401. Epub 2012 Nov 8.

26. Albayrak Y, Ugurlu GK, Ugurlu M, Cayköylü A. Beneficial Effects of Fluvoxamine for Chorea in a Patient With Huntington's Disease: A Case Report. Prim Care Companion CNS Disord. 2012;14(6):PCC.12l01369. doi: 10.4088/PCC.12l01369

27. Albayrak Y, Еzbay Y. P-1123 – Beneficial Effects of Fluvoxamine for Tardive Dyskinesia: Report of two Cases. Eur Psychiatry. 2012;27:1. doi: 10.1016/S0924-9338(12)75290-2

28. Uslu ET, Mengi M, Beyazyüz E, et al. The effects of sigma-1 agonist fluvoxamine on experimental induced tardive dyskinesia model in rats. Prog Neuropsychopharmacol Biol Psychiatry. 2023 Aug 30;126:110787. doi: 10.1016/j.pnpbp.2023.110787. Epub 2023 May 23.