CARM ID: 143266
Age: 8 years
Gender: Female
Medicine(s): Dexamfetamine, atomoxetine
Reaction(s): Drug interaction, dystonia

A child on long-term treatment with dexamfetamine was started on atomoxetine. Three months later she experienced dystonia of the jaw, which stopped following discontinuation of atomoxetine.

Atomoxetine and dexamfetamine affect noradrenaline. The Aspen Dexamfetamine, Dexamfetamine (Noumed), Strattera and Apo-Atomoxetine data sheets describe the potential for additive or synergistic pharmacological effects with concomitant use of medicines that affect noradrenaline.

The Aspen Dexamfetamine and Dexamfetamine (Noumed) data sheets also describe an interaction with atomoxetine. Concomitant use may lead to additive adverse effects, such as psychosis and movement disorders. The effects of amfetamines on mood and blood pressure may be reduced.

CARM ID: 147932
Age: 18 years
Gender: Male
Medicine(s): Orphenadrine
Reaction(s): Visual hallucination, auditory hallucination

Five days after starting orphenadrine, the patient developed visual and auditory hallucinations.

Hallucinations (frequency unknown) are listed in the Norflex data sheet.

CARM ID: 148121
Age: 62 years
Gender: Female
Medicine(s): Sulfamethoxazole + trimethoprim
Reaction(s): Aseptic meningitis

Two days after starting oral sulfamethoxazole + trimethoprim (co-trimoxazole), the patient experienced nausea and vomiting. She subsequently developed a frontal headache, neck pain, photophobia and fever. She was diagnosed with aseptic meningitis. The patient had also experienced these symptoms following previous administration of co-trimoxazole.

Aseptic meningitis is listed as a very rare adverse reaction in the Trisul data sheet.

CARM ID: 148278
Age: 3 years
Gender: Female
Medicine(s): Tocilizumab
Reaction(s): Hepatitis

The child developed significant liver dysfunction one year after starting tocilizumab. The symptoms improved following discontinuation of tocilizumab and initiation of prednisone.

The Actemra data sheet includes a hepatotoxicity warning in section 4.4. Serious hepatic injury, including acute liver failure, hepatitis and jaundice, has been reported between 2 weeks to more than 5 years after starting treatment.

CARM ID: 148394
Age: 69 years
Gender: Male
Medicine(s): Lisinopril, vildagliptin
Reaction(s): Swollen tongue

The patient commenced concomitant treatment with vildagliptin and lisinopril. One month later they developed swelling of the tongue, without rash. Treatment involved steroids, antihistamines and adrenaline, plus hospital admission. Lisinopril was discontinued.

The Lisinopril (Teva) data sheet warns that angioedema of the face, extremities, lips, tongue, glottis and/or larynx has been reported in patients treated with angiotensin converting enzyme inhibitors (ACE-inhibitors). Patients who only experience tongue swelling may require prolonged observation as treatment with antihistamines and corticoid steroids is not always sufficient. Advise patients to immediately report any signs or symptoms suggesting angioedema and to stop taking the medicine until they have consulted with their doctor.

The Galvus data sheet states that angioedema has been reported with vildagliptin, and a greater proportion of these cases were reported when vildagliptin was administered in combination with an ACE-inhibitor.

See also the March 2021 Prescriber Update article, Vildagliptin and ACE inhibitors – increased risk of angioedema.