Pamidronate associated hallucinations.

Abstract

Letters to the editor cance rating of one. The combinations of NSAIDs with a fi blocker, quinidine with cimetidine, and glibenclamide with a thiazide diuretic each occurred in one patient. These combinations have a significance rating of two. The combinations of NSAIDs with methotrexate, salicylates with enalapril, and digoxin with hydroxychloroquine each occurred in two patients. These combinations have a significance rating of four. None of the patients had reported a drug interaction before admission. The mean duration of admission was 39 days (range 7-84), during which time the only adverse reactions were diarrhoea secondary to auranofin in one patient and a skin rash secondary to sodium aurothiomalate in one patient. This small study supports previous studies illustrating the potential for drug interactions in patients with arthritis and emphasises the need for continued vigilance. Most potential drug interactions involve NSAIDs.' The absence of significant clinical drug interactions might be attributed to the judicious use of NSAIDs. They were reserved for the management of definite inflammation, and of the 33 patients receiving NSAIDs, 22 were receiving half the maximum recommended dose.

Intermittent Oral Disodium Pamidronate in Established Osteoporosis: A 2 Year Double-Masked Placebo-Controlled Study of Efficacy and Safety

“…A variety of rare side-effects have been reported associated with pamidronate which were not seen in this study. These incude ototoxicity with intravenous pamidronate [19], uveitis [20], impaired mineralization in Paget's disease [21], aseptic peritonitis [22] and hallucinations [23]. Side-effects noted with other bisphosphonates such as skin disease [24], renal failure [25], stress fractures [26] or pseudogout [27] were also not identified in this study.…”

Alendronate‐Induced Auditory Hallucinations and Visual Disturbances

“…Bisphosphonates, such as etidronate, 4,9 pamidronate, 10 and, in this case report, alendronate, have been associated with auditory hallucinations and visual disturbances. Clinicians should be aware of CNS toxicity as a rare but potential adverse effect associated with bisphosphonate therapy.…”

“…Adverse effects of the CNS similar to those seen in our patient have been associated with various bisphosphonates, specifically etidronate 9 and pamidronate. 10 Etidronate caused confusion and olfactory, auditory, and visual hallucinations in a 74-year-old woman after 1 week of therapy for prevention of osteoporosis. 9 The hallucinations ceased within 48 hours after discontinuation of the therapy and recurred on rechallenge.…”

“…4 Hallucinations have been associated with intravenous pamidronate. 10 A 75-year-old man who received intravenous pamidronate 90 mg for treatment of Paget's disease experienced visual hallucinations 2 hours after the completion of his first 24-hour infusion. The hallucinations increased in frequency and severity over the next 10 days.…”