P.036 Clarithromycin induced sleep paralysis: a case report and review of literature

Abstract

Background: Clarithromycin is a macrolide antibiotic, which has been successfully used for treating narcolepsy without cataplexy and primary hypersomnia. Sleep-paralysis has not been reported as a side effect of this medication. Methods: We report a 44-year-old right-handed female, who presented with three episodes of paralysis over 2-day. Each spell occurred upon awakening or while falling asleep lasting less than 2-minute. Only one episode was accompanied by tingling and numbness. She denied cataplexy, sleep attacks, hypnopompic and hypnagogic hallucinations. She had no history of similar episodes. She had never experienced migraine with or without aura. She was obese and suffered nocturnal snoring. She had recently been started on Clarithromycin for pneumonia. Her neurological examination was normal. Results: Brain MRI was normal. Stroke work up including carotids CT angiogram, 24-hour Holter monitoring and echocardiogram were unremarkable. Polysomnogram when she was not on Clarithromycin indicated mild obstructive sleep apnea and no narcolepsy. She had no further episodes of sleep paralysis after Clarithromycin was discontinued. Conclusions: We believe that administration of Clarithromycin was the cause of sleep paralysis. We hope that this case report increases awareness about this particular side effect of Clarithromycin and leads to further investigation about the etiology of sleep paralysis.