Acute Urinary Retention Related with Sublingual Buprenorphine Administration

Abstract

The Restless Leg Syndrome(RLS) induced by aripiprazole is very unique albeit rare adverse effect. The patient is a 55-year-old female who presented to our outpatient clinic with the diagnosis of major depressive disorder according to DSM-IV. Patient who has been receiving venlafaxine and quetiapine with doses of 75 mg/day and 300 mg/day respectively one year, was not being followed-up regularly. The patient had complaints such as suicidal thoughts and insomnia since the onset and gained 10 kg during the treatment. She was using ramipril 5 mg/day and her blood pressure follow-ups were normal. The venlafaxine dose of the patient was elevated to 150 mg/day and dose of quetiapine was remained same at 300 mg/day. Aripiprazol with a dose of 5 mg/day was added to the treatment of the patient due to complaints on the follow-up after a month. On the next one month follow up after the aripiprazole administration, patient stated that she suffered from insomnia, restlessness on legs, urge to move her legs and she had ceased the medication after 5 days. Her complaints were recovered after the cessation of the aripiprazole administration. The biochemistry, blood glucose, hemogram, iron, ferritine, transferrin level, renal hepatic test results, thyroid function tests, B12, and folic acid levels of the patient were all within normal range. Patient was evaluated by the departments of neurology and internal medicine and no peripheral neuropathic or vascular disease were found. There were no similar complaints before the aripiprazole treatment. Treatments of venlafaxine 150 mg/day and quetiapine 300 mg/day were continued. Venlafaxine dose was elevated to 225 mg/day but this dose was terminated gradually due to onset hypertension and depressive findings, duloxetine treatment with a dose of 30 mg/day was initiated, treatment of quetiapine 300 mg/day was resumed as unchanged. Duloxetine dose was increased up to 120 mg/day. RLS symptoms were not recurred during this period. Depressive symptoms of the patient remitted and treatment have been proceeding for one year. In our case, the symptoms have been considered as a result of aripiprazole administration due to occurrence of the symptoms after the initiation of aripiprazole treatment, recovery of the symptoms after cessation of aripiprazole, absence of and organic disease causing RLS, normal lab results, and lack of similar picture in patient’s history. The patient has been using venlafaxine and quetiapine for one year and no RLS symptoms were reported since then. Although the onset venlafaxine and quetiapine medication was proceeding, RLS symptoms were not observed after cessation of aripiprazole. In literature, a case of RLS related with the combination of venlafaxine and quetiapine was reported. RLS symptoms were remitted when aripiprazole was added to treatment. The inflammation of the RLS by D2 receptor antagonists and well response of the symptoms to dopaminergic drugs such as levodopa, suggest that the dopaminergic system acts as central role. Both improvement and causation of the RLS symptoms by aripiprazole can be explained by the partial agonistic effect on D2 receptors. RLS may cause depression or anxiety as well as sleeping disorder and affect the quality of life. Considering this reported side effect, especially in patients who was administered antipscyhotics, would be important for treatment follow-up and early diagnosis and treatment compliance in case this adverse effect is ensued.