Mood Stabilizer Therapy and Pravastatin: Higher Risk for Adverse Skin Reactions?

Abstract

Summary:We report on a serious side effect in a severely depressed 55-year-old woman, who presented an erythematous pigmented skin rash on the whole body under combination treatment with antidepressants, atypical antipsychotic drugs, the mood stabilizer lithium and the lipid-lowering drug pravastatin. The skin rash effect was most probably due, in first line, to olanzapine, but the cutaneous skin condition was triggered and aggravated by pravastatin, a 3-hydoxy-3-methylglutaryl-coenzyme A-(HMG-CoA)-reductase inhibitor, and lithium medication. The allergic reaction started to develop after co-administration of pravastatin. Therefore, the combination of atypical antipsychotics with statins should be carefully monitored and the benefits and disadvantages should be balanced.

Importance of Footwear for Preventing Xerosis and Hyperkeratosis in Older People with Psychiatric Disorders Living in an Institution

“…Some studies have demonstrated the influence of medication with psychotropic drugs on foot disorders [ 31 , 32 , 33 ]. Because medication could have influenced the results obtained, we analyzed the participants who took these drugs, statistically demonstrating that the type of footwear was a factor influencing the prevalence of xerosis.…”

Pravastatin-Induced Eczematous Eruption Mimicking Psoriasis

“…Case reports suggest that drug-drug interactions and genetic predispositions may precipitate adverse reactions for patients taking pravastatin; statins are very well tolerated overall. From searching the literature, three cases identified pravastatin as the cause of an adverse reaction [ 12 , 15 , 18 ]. All of the patients described were taking other medications, which may have influenced systemic exposure to pravastatin.…”

Antipsychotics and rashes

“…Olanzapine Long acting injection 4 Unspecified Site of injection Oral 5 Pruritic, pigmented (allergic) Whole body, especially on her neck, neckline and shanks Oral 6 Pustules, erythema, pruritus Whole body, concentrated especially on her neck and face Oral 7 Erythematous Dependent areas of body (biopsy confirmed leukocytodastic vasculitis) Oral disintegrating tablet 8 Purpuric Generalized Clozapine Oral 9 Confluent, erythematous macules Trunk and lower extremities Oral 10 Erythematous macules Diffuse around neck and chest Oral 11 Itchy urticarial Hands and limbs and the back, particularly in the pressurized area Oral 12 Papular, pruritic, erythematous, Started on torso and spread to extremities and very well circumscribed Oral 13 Erythematopustular Unspecified Quetiapine Oral 14 Psoriatic Unspecified Aripiprazole Oral 15 Morbilliform maculopapular Anterior aspect of the chest and abdomen to the upper and lower limbs sparing the face and scalp and mucosal areas (buccal cavity)…”

“…Rashes due to antipsychotic use that were reported in the literature are summarized in Table 1. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] In the psychiatric setting, rashes are most commonly associated with the mood stabilizer lamotrigine. However, it is important to realize the other skin manifestations after antipsychotic treatments.…”