Promethazine treatment of steroid-induced psychosis in a child

Dena G. Ingram, Tracy Hagemann

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

OBJECTIVE: To report a case of steroid-induced psychosis in a child that resolved with the treatment of promethazine, a phenothiazine derivative. CASE SUMMARY: A 2-year-old white boy with a history of relapsed acute lymphoblastic leukemia underwent a bone marrow transplant and developed graft-versus-host disease, which was treated with methylprednisolone. Within 24 hours of initiation of the methylprednisolone, the patient developed symptoms associated with steroid-induced psychosis including mania, head-banging, and excessive crying. Because the corticosteroid could not be discontinued, promethazine, a phenothiazine derivative, was used to treat the psychotic symptoms. Symptoms resolved with use of promethazine. DISCUSSION: A number of published reports describe the appearance of psychological symptoms with corticosteroid use. While the mechanism is unclear, the reaction is usually reversible with dose reduction or discontinuation of the corticosteroid. In cases where this cannot be done, typical treatment involves an antipsychotic medication. Most antipsychotic medications, such as the phenothiazine class, have not been evaluated in very young childen. Promethazine is a phenothiazine derivative that has been used in children for a number of nonpsychiatric indications. CONCLUSIONS: Promethazine may be effective in treating steroid-induced psychosis in pediatric patients.

Original languageEnglish (US)
Pages (from-to)1036-1039
Number of pages4
JournalAnnals of Pharmacotherapy
Volume37
Issue number7-8
DOIs
StatePublished - Jan 1 2003
Externally publishedYes

Fingerprint

Promethazine
Psychotic Disorders
Steroids
Adrenal Cortex Hormones
Methylprednisolone
Antipsychotic Agents
Stereotypic Movement Disorder
Therapeutics
Crying
Graft vs Host Disease
Bipolar Disorder
Precursor Cell Lymphoblastic Leukemia-Lymphoma
varespladib methyl
Bone Marrow
Pediatrics
Psychology
Transplants
phenothiazine

All Science Journal Classification (ASJC) codes

  • Pharmacology (medical)

Cite this

Promethazine treatment of steroid-induced psychosis in a child. / Ingram, Dena G.; Hagemann, Tracy.

In: Annals of Pharmacotherapy, Vol. 37, No. 7-8, 01.01.2003, p. 1036-1039.

Research output: Contribution to journalArticle

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