Reactions 1259 - 4 Jul 2009

SChloroquine/sulfasalazine

Mood disorder: case reportA 39-year-old woman with rheumatoid arthritis

developed mood disorder during concomitant treatmentwith chloroquine and sulfasalazine.

The woman had previously received chloroquine250 mg/day for 9 months, without psychiatric adverseeffects. Chloroquine had been stopped once her arthritissymptoms improved; however, her symptoms laterrecurred and she received methotrexate 7.5 mg/week. Afterexperiencing oedema and swelling, methotrexate wasstopped as it was presumed to be the cause. Shesubsequently started receiving chloroquine 250 mg/dayplus sulfasalazine 2 g/day.

The woman visited her rheumatologist 3 days after theemergence of psychiatric symptoms [time to onset notclearly stated] and her medications were stopped. She wasreferred to an emergency clinic (about 2 months afterinitiating chloroquine and sulfasalazine) with symptomssuch as insomnia, suicidal tendency, increased energy andbehavioural changes. She had auditory hallucinations andgrandiose, persecutive and erotomanic type delusions. Herfamily refused authorisation for her to be hospitalised andshe started receiving risperidone and ketiapin [sic] as anoutpatient, with improvement in her symptoms. Consentwas later gained for her hospitalisation and laboratoryinvestigations, EEG and brain CT scans were all normal. Hersymptoms resolved completely and she was dischargedwith a diagnosis of substance-induced mood disorderaccording to DSM IV-TR. At 6 months’ follow-up, she hadnot experienced any further psychiatric disorders.

Author comment: "[W]e concluded that her psychiatricsymptoms could well be due to [sulfasalazine], given thatemergence of the symptoms consistent with the data on theadverse effects of [sulfasalazine] are seen in the first 2-3months. However, the simultaneous withdrawal of the drugsmakes it hard for us to decide which one could have inducedthe symptoms. Another possibility seems to be that thecombination of chloroquine and [sulfasalazine] could accountfor the emergence of psychiatric symptoms."Gulec G, et al. Sulfasalazine plus chloroquine-induced mood disorder in a patientwith rheumatoid arthritis. Iranian Journal of Medical Sciences 34: 72-75, No. 1,Mar 2009 - Turkey 801146290

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Reactions 4 Jul 2009 No. 12590114-9954/10/1259-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved