An Interaction Between Levodopa and Enteral Nutrition Resulting in Neuroleptic Malignant-Like Syndrome and Prolonged ICU Stay
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Auteurs : André Bonnici [Canada] ; Carola-Ellen Ruiner [Canada] ; Lyne St-Laurent [Canada] ; David Hornstein [Canada]Source :
- The Annals of pharmacotherapy [ 1060-0280 ] ; 2010.
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Abstract
OBJECTIVE: To describe a probable interaction between enteral feeds and levodopa leading to neuroleptic malignant-like syndrome (NMLS) in a polytrauma patient with Parkinson's disease (PD). CASE SUMMARY: A 63-year-old morbidly obese male polytrauma patient with PD and type 2 diabetes mellitus was admitted to our intensive care unit postoperatively. Enteral feeds were administered per nasogastric tube and provided 0.88 g /kg/day of protein based on ideal body weight (IBW). His PD medications (pramipexole, entacapone, and immediate-release levodopa/carbidopa 100 mg/25 mg, 1.5 tablets 4 times daily) were administered via nasogastric tube. To achieve better glycemic control, his enteral feeds were changed to a formula that provided 1.8 g/kg/day of protein based on IBW. In the following 24 hours, the patient's mental status deteriorated and he was reintubated. He developed a high fever (40.5 °C), leukocytosis, elevated serum creatine kinase (CK) (480-1801 units/L), and acute renal impairment. His enteral nutrition was changed to decrease protein intake to 1.0 g/kg/day based on IBW and he was given bromocriptine 5 mg 3 times daily via nasogastric tube. Within 24 hours, the patient's mental status improved, his temperature and CK decreased, and his renal function began to improve; the values returned to baseline levels on the 18th day of admission. DISCUSSION: Withdrawal or dose reduction of levodopa in patients with PD has been reported to precipitate NMLS, which is potentially fatal. Because dietary protein can decrease the absorp0tion of levodopa, a potential for an interaction between levodopa and enteral feedings exists, although published reports of such an interaction are limited. In this patient, the likelihood that a drug-nutrient interaction occurred between levodopa and enteral feedings is considered to be probable based on the Naranjo probability scale and the Horn Drug Interaction Probability Scale. CONCLUSIONS: Health-care professionals should be aware of the interaction between levodopa and protein content of enteral nutrition to avoid the occurrence of NMLS in patients with PD.
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Internal Medicine and Critical Care, SMBD Jewish General Hospital, and McGill University Health Center, Montreal General Hospital</s1><s3>CAN</s3><sZ>4 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Department of Medicine, Faculty of Medicine, McGill University; Internal Medicine and Critical Care, SMBD Jewish General Hospital, and McGill University Health Center, Montreal General Hospital</wicri:noRegion></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">INIST</idno><idno type="inist">10-0439685</idno><date when="2010">2010</date><idno type="stanalyst">PASCAL 10-0439685 INIST</idno><idno type="RBID">Pascal:10-0439685</idno><idno type="wicri:Area/PascalFrancis/Corpus">000393</idno><idno type="wicri:Area/PascalFrancis/Curation">000884</idno><idno type="wicri:Area/PascalFrancis/Checkpoint">000393</idno><idno type="wicri:explorRef" wicri:stream="PascalFrancis" wicri:step="Checkpoint">000393</idno><idno type="wicri:doubleKey">1060-0280:2010:Bonnici A:an:interaction:between</idno><idno type="wicri:Area/Main/Merge">001E83</idno><idno type="wicri:Area/Main/Curation">001D43</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">An Interaction Between Levodopa and Enteral Nutrition Resulting in Neuroleptic Malignant-Like Syndrome and Prolonged ICU Stay</title><author><name sortKey="Bonnici, Andre" sort="Bonnici, Andre" uniqKey="Bonnici A" first="André" last="Bonnici">André Bonnici</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>McGill University Health Centre, Université de Montréal</s1><s2>Montreal, Quebec</s2><s3>CAN</s3><sZ>1 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Montreal, Quebec</wicri:noRegion></affiliation></author><author><name sortKey="Ruiner, Carola Ellen" sort="Ruiner, Carola Ellen" uniqKey="Ruiner C" first="Carola-Ellen" last="Ruiner">Carola-Ellen Ruiner</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Faculty of Medicine, McGill University and McGill University Health Centre</s1><s3>CAN</s3><sZ>2 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Faculty of Medicine, McGill University and McGill University Health Centre</wicri:noRegion></affiliation></author><author><name sortKey="St Laurent, Lyne" sort="St Laurent, Lyne" uniqKey="St Laurent L" first="Lyne" last="St-Laurent">Lyne St-Laurent</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Department of Clinical Nutrition, McGill University Health Centre</s1><s3>CAN</s3><sZ>3 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Department of Clinical Nutrition, McGill University Health Centre</wicri:noRegion></affiliation></author><author><name sortKey="Hornstein, David" sort="Hornstein, David" uniqKey="Hornstein D" first="David" last="Hornstein">David Hornstein</name><affiliation wicri:level="1"><inist:fA14 i1="04"><s1>Department of Medicine, Faculty of Medicine, McGill University; Internal Medicine and Critical Care, SMBD Jewish General Hospital, and McGill University Health Center, Montreal General Hospital</s1><s3>CAN</s3><sZ>4 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Department of Medicine, Faculty of Medicine, McGill University; Internal Medicine and Critical Care, SMBD Jewish General Hospital, and McGill University Health Center, Montreal General Hospital</wicri:noRegion></affiliation></author></analytic><series><title level="j" type="main">The Annals of pharmacotherapy</title><title level="j" type="abbreviated">Ann. pharmacother.</title><idno type="ISSN">1060-0280</idno><imprint><date when="2010">2010</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">The Annals of pharmacotherapy</title><title level="j" type="abbreviated">Ann. pharmacother.</title><idno type="ISSN">1060-0280</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Enteral administration</term><term>Human</term><term>Interaction</term><term>Levodopa</term><term>Malignant syndrome</term><term>Parkinson disease</term><term>Prolonged</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Interaction</term><term>Lévodopa</term><term>Voie entérale</term><term>Syndrome malin</term><term>Prolongé</term><term>Maladie de Parkinson</term><term>Homme</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Homme</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">OBJECTIVE: To describe a probable interaction between enteral feeds and levodopa leading to neuroleptic malignant-like syndrome (NMLS) in a polytrauma patient with Parkinson's disease (PD). CASE SUMMARY: A 63-year-old morbidly obese male polytrauma patient with PD and type 2 diabetes mellitus was admitted to our intensive care unit postoperatively. Enteral feeds were administered per nasogastric tube and provided 0.88 g /kg/day of protein based on ideal body weight (IBW). His PD medications (pramipexole, entacapone, and immediate-release levodopa/carbidopa 100 mg/25 mg, 1.5 tablets 4 times daily) were administered via nasogastric tube. To achieve better glycemic control, his enteral feeds were changed to a formula that provided 1.8 g/kg/day of protein based on IBW. In the following 24 hours, the patient's mental status deteriorated and he was reintubated. He developed a high fever (40.5 °C), leukocytosis, elevated serum creatine kinase (CK) (480-1801 units/L), and acute renal impairment. His enteral nutrition was changed to decrease protein intake to 1.0 g/kg/day based on IBW and he was given bromocriptine 5 mg 3 times daily via nasogastric tube. Within 24 hours, the patient's mental status improved, his temperature and CK decreased, and his renal function began to improve; the values returned to baseline levels on the 18th day of admission. DISCUSSION: Withdrawal or dose reduction of levodopa in patients with PD has been reported to precipitate NMLS, which is potentially fatal. Because dietary protein can decrease the absorp0tion of levodopa, a potential for an interaction between levodopa and enteral feedings exists, although published reports of such an interaction are limited. In this patient, the likelihood that a drug-nutrient interaction occurred between levodopa and enteral feedings is considered to be probable based on the Naranjo probability scale and the Horn Drug Interaction Probability Scale. CONCLUSIONS: Health-care professionals should be aware of the interaction between levodopa and protein content of enteral nutrition to avoid the occurrence of NMLS in patients with PD.</div></front></TEI></record>Pour manipuler ce document sous Unix (Dilib)
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