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Promethazine Treatment of Steroid-Induced Psychosis in a Child

at time of writing, PharmD Student, College of Pharmacy, University of Oklahoma, Oklahoma City, OK; now, Pharmacy Resident, Claremore Indian Hospital/Indiana Health Service, Claremore, OK

Tracy M Hagemann, PharmD

Assistant Professor, Department of Pharmacy: Clinical and Administrative Sciences, College of Pharmacy, University of Oklahoma, Oklahoma City

Reprints: Tracy M Hagemann PharmD, Department of Pharmacy: Clinical and Administrative Sciences, 1110 N. Stonewall, Oklahoma City, OK 73190-5040, FAX 405/271-6430, E-mail Tracy-Hagemann{at}ouhsc.edu

OBJECTIVE: To report a case of steroid-induced psychosis in a child that resolved with the treatment of promethazine, a phenothiazine derivative.

CASE SUMMARY: A 2-year-old white boy with a history of relapsed acute lymphoblastic leukemia underwent a bone marrow transplant and developed graft-versus-host disease, which was treated with methylprednisolone. Within 24 hours of initiation of the methylprednisolone, the patient developed symptoms associated with steroid-induced psychosis including mania, head-banging, and excessive crying. Because the corticosteroid could not be discontinued, promethazine, a phenothiazine derivative, was used to treat the psychotic symptoms. Symptoms resolved with use of promethazine.

DISCUSSION: A number of published reports describe the appearance of psychological symptoms with corticosteroid use. While the mechanism is unclear, the reaction is usually reversible with dose reduction or discontinuation of the corticosteroid. In cases where this cannot be done, typical treatment involves an antipsychotic medication. Most antipsychotic medications, such as the phenothiazine class, have not been evaluated in very young childen. Promethazine is a phenothiazine derivative that has been used in children for a number of nonpsychiatric indications.

CONCLUSIONS: Promethazine may be effective in treating steroid-induced psychosis in pediatric patients.

Key Words: corticosteroid, pediatrics, promethazine, psychosis

Published Online, June 5, 2003. www.theannals.com, DOI 10.1345/aph.1A271

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