P.8.b.006 Side effects of zolpidem and temazepam in treating primary insomnia

Abstract

There were no abnormalities in cardiovascular status. Baseline laboratory results again included a normal platelet count, normal liver enzymes and liver function tests. Hypomania was also excluded. After agomelatine discontinuation, symptoms improved. Adverse effect was determined by clinical pharmacist with the Naranjo probability scale and was probably associated with agomelatine use (6 points) and possibly associated with duloxetine hydrochloride use (4 points). After discussing the benefits and risks with the patient, a clinical pharmacist advised discontinuation of agomelatine and switching to trazodone 50mg daily at bedtime. The physician accepted our recommendations and the symptoms completely disappeared in three days after agomelatine discontinuation. Discussion: No case of agomelatine-induced sweating has been described. The interactions with agomelatine are reported to be mediated by cytochrome CYP1A2 enzymes. CYP1A2 and CYP2D6 have a major role in the metabolism of duloxetine hydrochloride and duloxetine hydrochloride increases the exposure of drugs that metabolized with CYP2D6, but not CYP1A2 [1]. Consequently any pharmacokinetics drug interaction between agomelatine and duloxetine hydrochloride had not occurred in this patient. An adverse effect was not induced by duloxetine hydrochloride itself, but pharmacodynamic drug–drug interaction between duloxetine hydrochloride and agomelatine could occur, which led to small additive adrenergic overstimulation. Such case has not yet been described in literature, however an adverse effect associated with drug–drug interaction can occur, as this report clearly demonstrates. No case of agomelatine-induced sweating has been described. Pharmacodynamic drug–drug interaction between agomelatine and duloxetine hydrochloride could occur, which led to small additive adrenergic overstimulation. Daily dose of duloxetine hydrochloride was not changed in switching time. This case serves to illustrate how clinical pharmacy can help ensure a satisfactory clinical outcome and prevent a potentially life threatening adverse drug reaction, similar to other case reports of timely recognition of adverse drug reactions from other psychotropic medications by clinical pharmacy that were followed by close collaboration between clinical pharmacy and psychiatry for successful management of the clinical disorder in question [2,3]. Conclusion: The benefit of this antidepressant combination needs to be carefully balanced with the risks associated with its use. Antidepressant combination treatment is common in some clinical practice settings, there is limited evidence to support this practice. Trazodone in small doses could be used in treating patients with agomelatine associated excessive sweating.