Abstract- Poster

Abstract

Pages: 2Word count: 250 ()Acknowledgement: NoneIntroduction-Abuse of antihistamines alone or in combination with other substances have been known for decades. Antihistamine containing cough syrups, cough suppressants, pheniramine maleate (Avil) tablets and injections are available easily as over-the-counter (OTC) medications. Psychological tolerance to the sedation and physical withdrawal symptoms following pheniramine abuse have been documented but surveying literature on pheniramine dependence yielded limited case reports on the same. Hereby, we present a unique case of pheniramine dependence, which is first of its kind ever reported of such mega doses of pheniramine abuse.Case report-A 29 years old Indian male presented to the psychiatry outpatient with history of abuse of heavy doses of pheniramine with opioids parenterally subsequently developing dependence, and injecting pheniramine up to 1700 mg daily. To obtain such high doses he purchased pheniramine meant for veterinary use (Panavil). He was started on tapentadol 300 mg, pregabalin 150 mg and quetiapine 50 mg. Tapentadol was down-tapered. Clinical opiate withdrawal scale (COWS) decreased from 13 on the day of admission to 4 on discharge. The patient was started on relapse prevention therapy and was discharged on tapentadol 50 mg, pregabalin 75 mg and quetiapine 25 mg with plan to continue psychotherapy sessions on follow up.Conclusion-Our case concludes that pheniramine has a dependence potential. OTC medication abuse seem to be under-reported and could be an emerging medical concern in the ensuing years. We enunciate the need of formulation of specific rules and regulations to supervise the availability of both human and veterinary drugs.