Unusual Manifestations Associated with a Phenothiazine-Induced Dystonic Reaction

Abstract

• Semper Vigilante-always be alert. The physician must know not only the disease he is treating, but must also be thoroughly acquainted with the drugs he uses. Side effects of drugs may produce symptoms which, if one is not alert, can be mistaken for complications of the underlying disease or the concomitant appearance of a new disease. It is the purpose of this report to present a case in which the occurrence of unexpected and undesirable reactions took place while using the usual recommended dose of a drng, and to describe a method of detection in the urine. Both are apparently not too well known. The phenothiazines are known to be cap­ able of producing neuromuscular reactions of three types: pseudo-parkinsonism, akathisia, and dystonia. Their frequency of occurrence and severity appear to be related to the amount of the drug administered,! and al­ though major seizures may occur at any time during treatment with phenothiazines, they usually occur with high doses. According to Ayd, these reactions occur only in predis­ posed individuals, and while akathisia and parkinsonism occur more frequently in women, dystonia occurs more frequently in men. He also observed that the time of onset of these reactions appears to be related to the type of phenothiazine administered, its chemical structure, milligram potency, route of admin­ istration, and the dosage used. They appear earlier in the course of therapy and with pro­ gressively smaller doses as the more potent compounds are used, particularly if the drug is administered intramuscularly or rectally. Difficulty in swallowing and speaking have been reported in connection with phenothia­ zine-induced dystonia.' There have also been a few reports of respiratory difficulties in such patients, but the case reported here is believed to be the first where shallow res