Antipsychotics & hypothermia

[Celexa]

What are your experiences with patients having HYPOthermia (not hyperthermia/NMS) as a side effect of antipsychotic therapy? I encountered my first case where this seems to be happening and am not sure what to make of it. From what little literature we could find it seems very rare and to be most common in the time periods after initiation or dose change, neither of which apply to my patient. They also have it as a documented reaction to multiple prior antipsychotics which are quite different from each other.

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[Celexa]

This is definitely a thing, have had quite a few cases. Assuming there is no other more plausible explanation (everyone loves to blame the psych meds) you should assume it's the antipsychotic.

If a patient gets it with one antipsychotic, have you seen them get it again with different ones?

I don't want to be identifying but the issue here isn't whether the patient has ever had anti-psychotic induced hypothermia (I think they have) it's whether this round of medical illness requiring hospitalization is due to the antipsychotic or something else. I favor the 'something else' (most likely an unidentified infection which was treated by the empiric antibiotics) as do the colleagues I've discussed the case with, but it's certainly not universally shared as an opinion.

One thing Ive found interesting is that the CL docs I've spoken to overall haven't seen this very much, whereas it's the outpatient docs who have, which sort of indirectly supports our current formulation in that it doesn't seem to be associated with severe illness. After all CL usually sees the most severe consequences of medications--we've all seen malignant catatonia/NMS, serotonin syndrome, lithium toxicity, seizures after wellbutrin... Apparently not hypothermia, though.

 

[splik]

I mean hypothermia can be potentially fatal and there are case reports of death with antipsychotic induced hypothermia.
One case I had was with Invega LAI. It seemed to resolve. I dont know what happened w/ the pt after discharge.
Another case I had was with ziprasidone. We switched to a different antipsychotic (I don't remember which) and it resolved.
A third case, I don't recall the antipsychotic but the pt was acutely manic and since the pt was hospitalized we decided to continue treatment with close monitoring and they were fine.

I've also been consulted on cases where the medical team was concerned that it was antipsychotic related but there were to me other obvious causes (e.g. sepsis) and I opined that I didnt think it was the antipsychotic and it wasnt appropriate to stop it.

This was all doing inpatient C-L. I doubt outpatient docs would see it more since it's not as common to check temperatures in the outpatient setting. it's probably underdiagnosed.

 

[Stagg737]

Never seen it with antipsychotics before. I have seen one case on CL possibly attributable to depakote, but was relatively mild and didn’t cause major issues.

Generally speaking, an acute symptom shouldn’t just randomly occur with no med changes unless something else triggers it. Maybe the AP is exacerbating it, but agree with you that it doesn’t seem to be the inciting factor here.

 

[whopper]

I've never seen this happen ever, but I've seen a patient get hypothermia due to Valproic Acid. It's a good thing to know cause if it happens, at least you won't flip out and know it's a possible side effect. In the case I saw, turned out had the patient's temperature dropped another 2 degrees F he might've lost temperature regulation for the rest of his life. I forgot the exact temperature he had, but there's a body of data out there showing if the temperature gets out of whack too much and too long the part of the brain that does T regulation gets permanently screwed.

 

[ObsequiousAplomb]

I forgot the exact temperature he had, but there's a body of data out there showing if the temperature gets out of whack too much and too long the part of the brain that does T regulation gets permanently screwed.

I seem to remember a documentary about this starring Bill Murray.