BACKGROUND: Pheniramine abuse is reported not only in patients with psychiatric disorders but also in the general population. CASE REPORT: We report a case of pheniramine dependence in a patient with obsessive-compulsive disorder. The patient took about 250 mg orally daily and injected about 90 mg every week from the last six months. It reduced his anxiety, was cheaper than his other psychiatric medications, and free of stigma. He had lethargy, headache, uneasiness, anxiety, and poor sleep as withdrawal symptoms. RESULTS: This case highlights the vulnerability of those with psychiatric disorders towards pheniramine abuse. Hence, this report advocates the strict evaluation of over-the-counter drugs for patients with pre-existing psychiatric disorders.

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Letter to the Editor report documented the serial cognitive improvement in a patient on renal dialysis as the serum urea level of 1216 mg/dl and a creatinine level of 27 mg/dl gradually reduced. 2 Those authors found that a rapid correction of urea may lead to higher osmolality disturbances and worse cognitive outcomes. The rate of accumulation of urea and creatinine may be equally important for cognitive disturbances to occur. For this, we require prospective studies to determine the rate of change for these products. This unusual case also shows the need of routine baseline investigations in every patient we treat.