Worsening Choreoathetosis in Huntington ’s Disease with Fluoxetine, Lisdexamfetamine, and Melatonin: A Case Report

Conclusion Our case is the second to describe worsened choreoathetoid movements with fluoxetine and psychostimulants in HD, and the first with melatonin. These observations are objectified by our patient’s marked improvements in movement and handwriting assessments (Figure 1).   We calculated Naranjo adverse event scores of 5, 5, and 2 for fluoxetine, lisdexamfetamine, and melatonin, respectively, based on several years of this individual’s outpatient medical records and current available literature (Table 1). Due to physiological and biochemical changes associated with HD progression, these medications could have different effects depending on HD staging. Melatonin has shown to be neuroprotective in toxicological and genetic models of HD, but it has not been studied in humans. However, if these neuroprotective effects hold true, there might be a possible use of melatonin in the late akinetic stages of HD. Fluoxetine and lisdexamfetamine appear to have worsened this patient’s chorea, likely due to their dopaminergic effects and presumed increased serum concentrations caused by this patient’s status as a CYP 2D6 poor metabolizer and other drug–drug interactions. Based on this, it might be prudent to use caution when initiating psychostimulants, fluoxetine, or melatonin in patients with known early-to-middle stage HD. Also, individuals who present with new or worsened choreoathetoid movements following administration of lisdexamfetamine, fluoxetine, or melatonin ...
Source: Innovations in Clinical Neuroscience - Category: Neuroscience Authors: Tags: Case Report Current Issue Neurodegenerative Disease amphetamine antidepressant chorea dopamine Fluoxetine Huntington’s disease melatonin psychostimulant Source Type: research