Postinjection delirium/sedation syndrome in a transgender man undergoing hormone therapy
Background: Long-acting injectable medications have become an important tool in the treatment of schizophrenia and schizoaffective disorder due to the high rates of medication nonadherence. Olanzapine long-acting injection (OLAI) is a useful therapeutic option for patients who have good tolerability...
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| Format: | Article |
| Language: | English |
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American Association of Psychiatric Pharmacists
2023-08-01
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| Series: | Mental Health Clinician |
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| Online Access: | https://theijpt.org/doi/pdf/10.9740/mhc.2022.08.263 |
| _version_ | 1797383371201970176 |
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| author | Joshua Gerving, PharmD, BCPS, BCPP Heather Walser, PharmD, BCPP Anne C. Kelly, MD |
| author_facet | Joshua Gerving, PharmD, BCPS, BCPP Heather Walser, PharmD, BCPP Anne C. Kelly, MD |
| author_sort | Joshua Gerving, PharmD, BCPS, BCPP |
| collection | DOAJ |
| description | Background: Long-acting injectable medications have become an important tool in the treatment of schizophrenia and schizoaffective disorder due to the high rates of medication nonadherence. Olanzapine long-acting injection (OLAI) is a useful therapeutic option for patients who have good tolerability and efficacy to oral olanzapine. Postinjection delirium/sedation syndrome (PDSS) is a rare but potentially serious event with the proposed mechanism of inadvertent intravascular injection of OLAI. This concern necessitates the requirement of a 3-hour monitoring period postinjection. Based on a literature review, there are no clearly defined risk factors for developing PDSS.
Case Report: A case is presented that describes PDSS in a transgender man undergoing hormone therapy with testosterone. The patient received OLAI for more than 3 years and developed PDSS 9 months after the initiation of injectable testosterone.
Discussion: There are published case reports of PDSS with the use of OLAI; however, there are no documented cases in a patient undergoing concurrent testosterone therapy. The effect that testosterone has on the vascular system and how it may alter the pharmacokinetics of OLAI has not been studied.
Conclusion: Despite proper injection technique, PDSS can occur after injection with OLAI. Further research is necessary to identify specific risk factors for the development of PDSS, including the potential effect that hormone therapy may have. |
| first_indexed | 2024-03-08T21:20:00Z |
| format | Article |
| id | doaj.art-1824c0a8ad7e4d28beed3c1334680f0b |
| institution | Directory Open Access Journal |
| issn | 2168-9709 |
| language | English |
| last_indexed | 2024-03-08T21:20:00Z |
| publishDate | 2023-08-01 |
| publisher | American Association of Psychiatric Pharmacists |
| record_format | Article |
| series | Mental Health Clinician |
| spelling | doaj.art-1824c0a8ad7e4d28beed3c1334680f0b2023-12-21T11:47:35ZengAmerican Association of Psychiatric PharmacistsMental Health Clinician2168-97092023-08-0112426326610.9740/mhc.2022.08.263i2168-9709-12-04-263Postinjection delirium/sedation syndrome in a transgender man undergoing hormone therapyJoshua Gerving, PharmD, BCPS, BCPP0https://orcid.org/0000-0001-8737-2605Heather Walser, PharmD, BCPP1https://orcid.org/0000-0001-9322-2048Anne C. Kelly, MD2https://orcid.org/0000-0003-3626-36811 Clinical Pharmacy Specialist, Boise Veterans Affairs Medical Center, Boise, Idaho2 Clinical Pharmacy Specialist, Boise Veterans Affairs Medical Center, Boise, Idaho3 Psychiatrist, Boise Veterans Affairs Medical Center, Boise, IdahoBackground: Long-acting injectable medications have become an important tool in the treatment of schizophrenia and schizoaffective disorder due to the high rates of medication nonadherence. Olanzapine long-acting injection (OLAI) is a useful therapeutic option for patients who have good tolerability and efficacy to oral olanzapine. Postinjection delirium/sedation syndrome (PDSS) is a rare but potentially serious event with the proposed mechanism of inadvertent intravascular injection of OLAI. This concern necessitates the requirement of a 3-hour monitoring period postinjection. Based on a literature review, there are no clearly defined risk factors for developing PDSS. Case Report: A case is presented that describes PDSS in a transgender man undergoing hormone therapy with testosterone. The patient received OLAI for more than 3 years and developed PDSS 9 months after the initiation of injectable testosterone. Discussion: There are published case reports of PDSS with the use of OLAI; however, there are no documented cases in a patient undergoing concurrent testosterone therapy. The effect that testosterone has on the vascular system and how it may alter the pharmacokinetics of OLAI has not been studied. Conclusion: Despite proper injection technique, PDSS can occur after injection with OLAI. Further research is necessary to identify specific risk factors for the development of PDSS, including the potential effect that hormone therapy may have.https://theijpt.org/doi/pdf/10.9740/mhc.2022.08.263antipsychotic agentsdrug-related side effects and adverse reactionsschizophreniaolanzapinetransgenderhormonal therapytestosterone |
| spellingShingle | Joshua Gerving, PharmD, BCPS, BCPP Heather Walser, PharmD, BCPP Anne C. Kelly, MD Postinjection delirium/sedation syndrome in a transgender man undergoing hormone therapy Mental Health Clinician antipsychotic agents drug-related side effects and adverse reactions schizophrenia olanzapine transgender hormonal therapy testosterone |
| title | Postinjection delirium/sedation syndrome in a transgender man undergoing hormone therapy |
| title_full | Postinjection delirium/sedation syndrome in a transgender man undergoing hormone therapy |
| title_fullStr | Postinjection delirium/sedation syndrome in a transgender man undergoing hormone therapy |
| title_full_unstemmed | Postinjection delirium/sedation syndrome in a transgender man undergoing hormone therapy |
| title_short | Postinjection delirium/sedation syndrome in a transgender man undergoing hormone therapy |
| title_sort | postinjection delirium sedation syndrome in a transgender man undergoing hormone therapy |
| topic | antipsychotic agents drug-related side effects and adverse reactions schizophrenia olanzapine transgender hormonal therapy testosterone |
| url | https://theijpt.org/doi/pdf/10.9740/mhc.2022.08.263 |
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