A manic episode in a patient with stable bipolar disorder triggered by intranasal mometasone furoate

Abstract

Sir, Intranasal corticosteroid sprays are a mainstay treatment for allergic rhinitis and other conditions. The usual drug prescription textbooks, such as the Physicians’ Desk Reference, do not mention mania as a possible adverse event. Confronted with a bipolar patient who developed a hypomanic episode after taking mometasone furoate, we briefly reviewed the literature on the topic of mania and nonsystemic corticosteroid therapy. We found three case reports published in the 1980s: one of an asthmatic child aged 5 who developed mania on inhaled budenoside [Lewis and Cochrane, 1983]; one of a 69-year-old patient who had previously presented prednisone-induced manic symptoms and developed mania on intranasal beclomethasone [Phelan, 1989]; and one of a 28-year-old known bipolar patient, who was stable and developed mania on intranasal beclomethasone [Goldstein and Preskorn, 1989]. We found two other studies reporting a possible link between intranasal corticosteroid sprays and mania: one was an online survey of 192 bipolar patients about possible triggers of affective episodes; antiallergic medication was a rarely reported possible trigger of mania [Proudfoot et al. 2012]; the other was a report of the International Pharmacovigilance Programme of the World Health Organization and reported seven cases of manic reactions attributed to intranasal corticosteroids, which were not described in further details [Pokladnikova et al. 2008]. We contribute to the literature with our case report.