Tolperisone, a centrally-acting muscle relaxant: a possible cause of macular haemorrhage

Tsokolas, Georgios; Almuhtaseb, Hussein; Hanifudin, Abdul; Lotery, Andrew

doi:10.1038/s41433-019-0578-9

Cited by 2 publications

(2 citation statements)

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“…described a case of vitreous hemorrhage ascribed to tolperisone. [ 29 ] Carisoprodol, gabapentin, and pregabalin have diverse cardiorespiratory, vasodilatory, and visual effects mediated through GABAergic pathways. [ 29 30 31 32 ] Doğan et al .…”

Section: Discussionmentioning

confidence: 99%

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The associations between central serous chorioretinopathy and muscle relaxants

Jain¹,

Garg²,

Chaudhary³

et al. 2022

Taiwan Journal of Ophthalmology

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PURPOSE: To evaluate the role of muscle-relaxants as risk factors for the development of central serous chorioretinopathy (CSC) - the second most common retinopathy in our settings; despite multiple risk factors seen in our patients, 21% were initially labelled as idiopathic. MATERIALS AND METHODS: Retrospective case-control study at a tertiary hospital in the United Arab Emirates, where we reviewed the medical records of 273 patients with CSC examined between 2010 and 2019 for use of muscle-relaxants including tolperisone/eperisone, carisoprodol and gabapentin/pregabalin within a year of onset/recurrence of the disease. Intake of drugs with known association with CSC (including corticosteroids/sympathomimetics) was also recorded. Two hundred eighty-six subjects with adverse events seen at the same institute during the same study period served as controls. Odds ratios, Chi-Square tests and multivariate logistic regression were carried out to determine any associations with the muscle-relaxants and other pharmacological confounders - corticosteroids/sympathomimetics. RESULTS: Muscle relaxants may increase the risk of CSC as evident on multivariate regression analysis (OR: 2.55; confidence interval [CI]: 1.208-5.413); the significance was retained on removing the 6 subjects who had corticosteroids/sympathomimetics (OR: 2.30; CI: 1.073–4.939). Univariate analysis yielded an OR of 2.52 for muscle relaxants (CI: 1.2149–5.2276), 2.96 for eperisone/tolperisone (CI: 1.3531–6.5038), and 6.26 for eperisone as an individual agent (CI: 1.8146–21.6252). CONCLUSION: We found muscle relaxants to be associated factors of CSC regardless of inclusion of corticosteroids/sympathomimetics ( P < 0.05). Among individual classes of muscle relaxants in this study, only eperisone/tolperisone posed a significant risk ( P < 0.05). The vascular smooth muscle relaxation could be the possible mechanism that affects the choroidal blood flow and indirectly predisposes to CSC.

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Section: Discussionmentioning

confidence: 99%

“…[ 29 ] Carisoprodol, gabapentin, and pregabalin have diverse cardiorespiratory, vasodilatory, and visual effects mediated through GABAergic pathways. [ 29 30 31 32 ] Doğan et al . have recently reported two cases of CSC with pregabalin as a probable cause.…”

Section: Discussionmentioning

confidence: 99%