Polypharmacy-Related Shock Symptoms and Complications Associated with Phenothiazine: A Case Report

Intern Med. 2023 Nov 13. doi: 10.2169/internalmedicine.2012-23. Online ahead of print.

Abstract

This report describes a case of shock symptoms in a 72-year-old woman with epilepsy who had been in a state of polypharmacy, taking multiple antipsychotic drugs. After receiving a normal dose of periciazine, she exhibited impaired consciousness, hypothermia, and hypotension and was admitted to hospital. Despite poor response to vasopressors, conservative treatment led to gradual improvement. Subsequent pharmacokinetic analysis showed non-toxic blood concentrations of periciazine, suggesting that even small doses of phenothiazines could result in toxic symptoms. This case highlights the importance of monitoring for adverse reactions when prescribing multiple antipsychotic drugs, particularly in older polypharmacy patients.

Keywords: Phenothiazine; adrenergic reversal; blood concentration; drug intoxication; polypharmacy.