Drug-induced Dysphagia Research Articles

Pharmacological considerations in antipsychotic drug selection for prevention of drug-induced dysphagia.

Antipsychotic drugs have the ability to induce dysphagia. The aim of this study was to determine the association between the receptor affinity of antipsychotic drugs and the time-to-onset of dysphagia, and to identify factors that prevent antipsychotic drug-induced dysphagia. We used the receptor affinity of 13 antipsychotic drugs for which data were reported in an in vitro test using human receptors, extracted time-to-onset dysphagia from the Japan Adverse Drug Event Report database, and used data from 46 patients to evaluate the correlation between receptor affinity and time-to-onset of dysphagia. We found a negative correlation between D₂ receptor affinity and time-to-onset of dysphagia (r = -0.4572, p = 0.0016), and a positive correlation between H1, M1, and M₃ receptor affinity and time-to-onset of dysphagia (r = 0.5006, p = 0.0006; r = 0.4130, p = 0.0059; and r = 0.4149, p = 0.0057, respectively). Antipsychotic drugs with a strong D₂ receptor-blocking action may accelerate the onset of dysphagia, whereas a strong H1, M1, and M₃ receptor-blocking action may delay the onset of dysphagia. The current study revealed the relationship between the receptor affinity of antipsychotic drugs and the time-to-onset of dysphagia, which should aid in the selection of antipsychotic drugs, while preventing dysphagia.

Drug-induced dysphagia in elderly patients

Drug-induced dysphagia in elderly patients

Laryngeal Suspension for Drug-induced Sarcopenic Dysphagia

Laryngeal Suspension for Drug-induced Sarcopenic Dysphagia

1759 Dysphagia in Extra-Pyramidal Syndrome: A Reversible and Uncommon Presentation

INTRODUCTION: Neuroleptic medications are known to cause extrapyramidal syndrome (EPS) in individuals taking antipsychotic medications. However, dysphagia is an uncommon clinical entity presenting as EPS. We present a case of dysphagia in an individual taking Haloperidol confirmed by swallowing studies, which resolved entirely on discontinuation of Haloperidol and appropriate medical management. CASE DESCRIPTION/METHODS: A 22-year-old male with a history of bipolar disorder was admitted to the inpatient psychiatric unit for an episode of psychosis. He was started on oral valproic acid, oral haloperidol as well as scheduled monthly injections of Haloperidol Decanoate. One week after his discharge, he was seen in the clinic for coarse tremors and stiffness in all his extremities. It was decided to taper haloperidol and start benztropine. In two weeks, he presented to the emergency room with difficulty in swallowing (both liquids and solids) as well as worsening stiffness of all four extremities. Physical examination was significant for masked facies, bradykinesia with decreased active range of motion of both the upper and lower extremities. A computed tomography (CT) of his head, neck, and soft tissues showed no acute abnormalities. A functional swallow evaluation was performed which revealed oral decompensation for regular solid texture, marked by excessive chewing and delayed anterior to posterior transit. There was no remarkable oral residue, symptoms or signs of airway protection deficits were appreciated on assessment. Esophagogastroduodenoscopy did not reveal any structural etiology for his dysphagia. He was admitted to hospital; haloperidol was discontinued and Benztropine dose was increased. Also, he was started on diphenhydramine His symptoms were completely resolved in four days. He was discharged home in stable condition. DISCUSSION: Extrapyramidal symptoms (EPS) are a well-known adverse reaction from antipsychotic medications, that can range from acute dystonia, akathisia, parkinsonism to tardive dyskinesia. Dysphagia is a known but rare side effect of antipsychotic medications. Our case stresses the importance of suspecting drug-induced dysphagia in individuals on neuroleptics. Early diagnosis can decrease morbidity and hospital stay as the main stay of management of these patients is to discontinue precipitating agent and reversing physiological effects by medical management that can result in shortening disease course and better outcomes.

SUN-PO039: Drug-Induced Dysphagia in Elderly Nursing Home Residents

SUN-PO039: Drug-Induced Dysphagia in Elderly Nursing Home Residents

Drug-induced dysphagia and the high-risk effect on people with intellectual disabilities

Drug-induced dysphagia and the high-risk effect on people with intellectual disabilities

Diagnosis and Clinical Course of Unexplained Dysphagia.

ObjectiveTo investigate the final diagnosis of patients with unexplained dysphagia and the clinical and laboratory findings supporting the diagnosis.MethodsWe retrospectively analyzed 143 patients with dysphagia of unclear etiology who underwent a videofluoroscopic swallowing study (VFSS). The medical records were reviewed, and patients with a previous history of diseases that could affect swallowing were categorized into a missed group. The remaining patients were divided into an abnormal or normal VFSS group based on the VFSS findings. The clinical course and final diagnosis of each patient were examined.ResultsAmong the 143 patients, 62 (43%) had a previous history of diseases that could affect swallowing. Of the remaining 81 patients, 58 (72.5%) had normal VFSS findings and 23 (27.5%) had abnormal VFSS findings. A clear cause of dysphagia was not identified in 9 of the 23 patients. In patients in whom a cause was determined, myopathy was the most common cause (n=6), followed by laryngeal neuropathy (n=4) and drug-induced dysphagia (n=3). The mean ages of the patients in the normal and abnormal VFSS groups differed significantly (62.52±15.00 vs. 76.83±10.24 years, respectively; p<0.001 by Student t-test).ConclusionCareful history taking and physical examination are the most important approaches for evaluating patients with unexplained swallowing difficulty. Even if VFSS findings are normal in the pharyngeal phase, some patients may need additional examinations. Electrodiagnostic studies and laboratory tests should be considered for patients with abnormal VFSS findings.

Prescription errors in geriatric patients can be avoided by means of a computerized physician order entry (CPOE).

The implementation of a computerized physician order entry (CPOE) can help reduce prescription errors in clinical practice. The aim of this study was to evaluate the effects of a CPOE for geriatric patients with the two most common conditions for drug-induced iatrogenic diseases, dysphagia and renal failure. A retrospective analysis of actual drug prescriptions versus CPOE recommendations in the geriatric department of the St. Marien Hospital in Cologne, Germany was carried out. Actual drug prescriptions were collected for 26 patients with dysphagia (15 female, 11 male, average age 82.3 ± 8.0 years) and 35 patients with renal failure (23 female, 12 male, average age 80.5 ± 6.7 years) which were compared with recommended prescriptions by means of a CPOE and discrepancies were statistically analyzed. Prescription errors for at least 1 drug were detected in 46 % of patients with renal failure and the administration of at least 1 drug with inadequate crushing was observed in 77 % of dysphagia patients. Prescription errors appear to be frequent to highly frequent in the medical routine even in a highly specialized geriatric setting. Inaccuracies might be reduced by the implementation of a CPOE and even more if coupled to a decision support system. Drug-drug or drug-disease interactions, which are particularly high risks in patients with multimorbidities, multidrug therapy, renal failure or malnutrition, might be kept under control through careful verification of medication indications, organ function status as well as drug administration and preparation in cases of tube feeding.

Paliperidone-Induced Dystonic Dysphagia

Back to table of contents Previous article Next article LETTERFull AccessPaliperidone-Induced Dystonic DysphagiaDattatreya Namdeorao Mendhekar D.P.M.,Ashish Agarwal M.D.,Dattatreya Namdeorao Mendhekar D.P.M.Search for more papers by this author,Ashish Agarwal M.D.Search for more papers by this author,Published Online:1 Oct 2010https://doi.org/10.1176/jnp.2010.22.4.451.e37AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: Acute dystonic reactions are well recognized, but isolated dystonia of the pharyngeal muscle causing dysphagia is a rare occurrence with neuroleptic drugs. Extended-release paliperidone is a newly introduced atypical antipsychotic medication formulated using the principal active metabolite of risperidone, 9-hydroxyrisperidone. In contrast to risperidone, it provides consistent and smooth plasma drug concentrations over 24 hours. 1 We report a young man who developed acute-onset dysphagia after taking paliperidone. Case ReportMr. S, an 18-year-old male student, presented with a history of being suspicious, irritable, withdrawn, muttering to self, and having grandiose ideas and disturbed biological functions for a duration of 1 year. He was diagnosed with schizophrenia (DSM-IV-TR criteria). He was treated with divalproex sodium, 750 mg/day, olanzapine, 30 mg/day, and clozapine, 100 mg/day, with marked recovery in psychotic symptoms. He remained stabilized for 3 months while continuing the same treatment. Subsequently, he stopped taking medicine and had a relapse within 2 weeks. This time he was treated with divalproex sodium, 500 mg/day, and paliperidone, 3 mg/day. At day 3, the dosage of paliperidone was increased to 6 mg/day. After taking only two doses of paliperidone at 6 mg/day and within 12 hours of his last dose of paliperidone, he started complaining of a choking sensation in his throat if he tried to ingest any solid or semisolid food and made gurgling sounds. He had little difficulty taking liquids, but solid food would stick in his throat. He presented with severe anxiety and was calling for help. By the time he was brought to the treating psychiatrist, within 4 hours, he also had difficulty making sounds of any kind.Neurological examination did not show any evidence of organic illness, and no abnormal movements were noticed on other parts of the body. He was given intramuscular promethazine, 50 mg, and within 30 minutes he showed remarkable recovery in swallowing. Otolaryngological and gastroenterological evaluation did not find any organic causes and confirmed a case of drug-induced dysphagia. His organic workup for dystonia, including EEG and brain MRI, was negative. Paliperidone was replaced by clozapine, 200 mg/day, with no further recurrence of dysphagia.Discussion The association between paliperidone and dystonic dysphagia is irrefutable in this report; the complaints developed shortly after the introduction of paliperidone and resolved with an anticholinergic drug. Dysphagia may be a manifestation of extrapyramidal side effect when it is associated with neuroleptic therapy. 2 Literature shows that patients with dystonic dysphagia frequently have oromandibular dystonia or neck dystonia, 3 but in our case it was an isolated phenomenon. The mechanism of action of paliperidone is unclear. Paliperidone may cause dystonia due to its dopamine D 2 -serotonin 5HT2A antagonist property. 1 Further, it can block alpha 2 adrenoceptors which can increase noradrenergic activity by inhibiting the autoreceptors. 4 Animal study has suggested that enhanced activity of central noradrenergic nuclei is one of the pathophysiologies of dystonia. 5Complaints of dysphagia in patients with schizophrenia are often overlooked, and this report shows that early diagnosis of neuroleptic-induced dysphagia can avoid potential complications and prevent the patient from undergoing extensive diagnostic testing and various drug trials.Neuropsychiatry and Headache Clinic, New Delhi, IndiaDepartment of Psychiatry, GB Pant Hospital, New Delhi

Paliperidone-Induced Dystonic Dysphagia

Back to table of contents Previous article Next article LETTERFull AccessPaliperidone-Induced Dystonic DysphagiaDattatreya Namdeorao Mendhekar D.P.M.,Ashish Agarwal M.D.,Dattatreya Namdeorao Mendhekar D.P.M.Search for more papers by this author,Ashish Agarwal M.D.Search for more papers by this author,Published Online:1 Oct 2010https://doi.org/10.1176/jnp.2010.22.4.451.e37AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: Acute dystonic reactions are well recognized, but isolated dystonia of the pharyngeal muscle causing dysphagia is a rare occurrence with neuroleptic drugs. Extended-release paliperidone is a newly introduced atypical antipsychotic medication formulated using the principal active metabolite of risperidone, 9-hydroxyrisperidone. In contrast to risperidone, it provides consistent and smooth plasma drug concentrations over 24 hours. 1 We report a young man who developed acute-onset dysphagia after taking paliperidone. Case ReportMr. S, an 18-year-old male student, presented with a history of being suspicious, irritable, withdrawn, muttering to self, and having grandiose ideas and disturbed biological functions for a duration of 1 year. He was diagnosed with schizophrenia (DSM-IV-TR criteria). He was treated with divalproex sodium, 750 mg/day, olanzapine, 30 mg/day, and clozapine, 100 mg/day, with marked recovery in psychotic symptoms. He remained stabilized for 3 months while continuing the same treatment. Subsequently, he stopped taking medicine and had a relapse within 2 weeks. This time he was treated with divalproex sodium, 500 mg/day, and paliperidone, 3 mg/day. At day 3, the dosage of paliperidone was increased to 6 mg/day. After taking only two doses of paliperidone at 6 mg/day and within 12 hours of his last dose of paliperidone, he started complaining of a choking sensation in his throat if he tried to ingest any solid or semisolid food and made gurgling sounds. He had little difficulty taking liquids, but solid food would stick in his throat. He presented with severe anxiety and was calling for help. By the time he was brought to the treating psychiatrist, within 4 hours, he also had difficulty making sounds of any kind.Neurological examination did not show any evidence of organic illness, and no abnormal movements were noticed on other parts of the body. He was given intramuscular promethazine, 50 mg, and within 30 minutes he showed remarkable recovery in swallowing. Otolaryngological and gastroenterological evaluation did not find any organic causes and confirmed a case of drug-induced dysphagia. His organic workup for dystonia, including EEG and brain MRI, was negative. Paliperidone was replaced by clozapine, 200 mg/day, with no further recurrence of dysphagia.Discussion The association between paliperidone and dystonic dysphagia is irrefutable in this report; the complaints developed shortly after the introduction of paliperidone and resolved with an anticholinergic drug. Dysphagia may be a manifestation of extrapyramidal side effect when it is associated with neuroleptic therapy. 2 Literature shows that patients with dystonic dysphagia frequently have oromandibular dystonia or neck dystonia, 3 but in our case it was an isolated phenomenon. The mechanism of action of paliperidone is unclear. Paliperidone may cause dystonia due to its dopamine D 2 -serotonin 5HT2A antagonist property. 1 Further, it can block alpha 2 adrenoceptors which can increase noradrenergic activity by inhibiting the autoreceptors. 4 Animal study has suggested that enhanced activity of central noradrenergic nuclei is one of the pathophysiologies of dystonia. 5Complaints of dysphagia in patients with schizophrenia are often overlooked, and this report shows that early diagnosis of neuroleptic-induced dysphagia can avoid potential complications and prevent the patient from undergoing extensive diagnostic testing and various drug trials.Neuropsychiatry and Headache Clinic, New Delhi, IndiaDepartment of Psychiatry, GB Pant Hospital, New Delhi

Extrapyramidal Syndrome Presenting as Dysphagia: A Case Report

Extrapyramidal symptoms are well-documented complications of therapy with haloperidol, even when small doses are used. Dysphagia, though uncommon, can be quite debilitating and can mimic a paraneoplastic syndrome. It is important to always review the medications the patient is taking and consider them as etiological culprits in any new symptom complex. This report highlights a case of drug-induced dysphagia in a patient receiving haloperidol for obsessive nocturnal thoughts and auditory disturbances.

Neuroleptic-Induced Dysphagia: Case Report and Literature Review

Neuroleptic medication may cause extrapyramidal symptoms (EPS) that can affect swallowing as well. This report describes a case of drug-induced dysphagia in a 53-year-old man receiving haloperidol for treatment of schizophrenia. The diagnosis was established by fiberoptic endoscopic evaluation of swallowing. After changing medication to fluphenazin, dysphagic symptoms resolved. The literature on EPS-related dysphagia, its demographic features, typical symptoms, diagnostic modalities, clinical course, and treatment options is reviewed.

Drug-induced esophageal injuries and dysphagia.

To review and analyze medical literature documenting drug-induced esophageal injury and dysphagia and to formulate strategies to enhance pharmacists' prevention, detection, and treatment of these iatrogenic complications. A MEDLINE search (1966-April 2002) was conducted to identify primary and secondary literature using variable combinations of the following search terms: pill-induced, drug-induced, or iatrogenic with esophageal injury, esophageal damage, or dysphagia. Bibliographies were also reviewed to identify additional relevant references. All case reports, reviews, and clinical studies relating to drug-induced esophageal injury or swallowing dysfunction were evaluated. Drug-induced esophageal injury may be under-recognized. Several drugs have been associated with physical or chemically mediated injuries. Risk factors for injury have been identified and preventive and treatment strategies have been successful in limiting esophageal injury. Drug-induced dysphagia can have serious complications and is most often associated with typical neuroleptics such as haloperidol. Pharmacists can play a pivotal role in proactively identifying situations where there is a higher likelihood of drug-induced esophageal injury or dysphagia. They can recommend preventive strategies to promote safe medication use, help identify iatrogenic complications when they occur, and assist in formulation of appropriate treatment strategies.

Drug-Induced Dysphagia

Drug-Induced Dysphagia

Drug-Induced Dysphagia

Abstract Dysphagia is commonly defined as difficulty swallowing. Although the disorder can have several causes, the patient's medication is often overlooked as a source of the problem. This type of dysphagia, one of the most readily corrected, is known as drug-induced dysphagia. A thorough literature search was undertaken to determine the potential for drug-induced dysphagia. Drug-induced dysphagia can be classified into one of three categories: dysphagia as a side effect, dysphagia as a complication of therapeutic action, and medication-induced esophageal injury. Examples of medications in each category are provided based on therapeutic classification. Specifically, the role of dysphagia in multiple sclerosis and the agents that have been linked with dysphagia are discussed. The most valuable method of preventing drug-induced dysphagia is obtaining a thorough and accurate medication history from each patient. Other prevention strategies and compensatory techniques are also explored.

Drug-induced dysphagia.

Dysphagia describes the disability or problems in swallowing a wet or dry bolus properly and is normally associated with an impaired transport of the bolus. Dysphagia can be accompanied by a pain sensation in the chest mostly caused by impaction of the food bolus in the esophagus. Odynophagia describes only the status of painful swallowing without an impairment of the swallow and transport function. Drug-induced dysphagia can be caused in two different ways. First as a normal drug side effect of the pharmacological action of the drug or as a complication of the therapeutic action of the drug. The normal drug side effect is most likely in drugs that affect smooth or striated muscle function or the sensitivity of the mucosa. The drug effect on smooth muscle function that causes dysphagia can be inhibitory or excitatory. Dysphagia is a common clinical symptom in patients with reduced perception of the pharyngeal mucosa which leads to an subjective impairment of swallowing. Dysphagia caused by a complication of the therapeutic action of a drug includes viral or fungal esophagitis in patients treated with immunosuppressive drugs or cancer therapeutic agents, or antibiotics and immunological reactions to certain drugs such as erythema exsudativa multiforme or Stevens-Johnson syndrome. Second, drug-induced dysphagia can be due to medication-induced esophageal injury (MIEI). In most cases this mucosal injury appears to be the direct result of prolonged contact of a potentially caustic drug with the esophageal mucosa. This form of medication-induced esophagitis is most likely to be found in elderly patients and patients with esophageal motility disorders.(ABSTRACT TRUNCATED AT 250 WORDS)

A Clinical Guide for Diagnosing and Managing Patients With Drug-Induced Dysphagia

Both Parkinson’s disease and tardive dyskinesia have been shown to cause a wide range of eating and swallowing disturbances that can result in life-threatening complications, such as sudden choking, aspiration, and malnutrition (1,2). Dysphagia, or difficulty swallowing, is a most reliable symptom and should not be dismissed as an emotional disturbance (3). Psychotropic medications are etiologically implicated in the swallowing disorders of patients with Parkinson’s disease and tadive dyskinesia by a variety ofpathophysiologic factors. First, dysphagia is present in up to 50 percent of patients with Parkinson’s disease, and complications from dysphagia are a frequent cause of death among these patients. The anatomic basis of swallowing dysfunction is demonstrated radiographically in the proximal pharyngeal and esophageal musculature (2). It is thought that these areas are predominantly under central dopaminergic control and treatable with antiparkinsonian agents. By blocking dopaminergic transmission, neuroleptic