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Pharmacopsychiatry 2002; 35(4): 152-154
DOI: 10.1055/s-2002-33193
Case Report
© Georg Thieme Verlag Stuttgart · New York

H2-Histamine Antagonist (Famotidine) Induced Adverse CNS Reactions with Long-Standing Secondary Mania and Epileptic Seizures

R. W. von Einsiedel1 , D. Roesch-Ely1 , K. Diebold1 , K. Sartor2 , C. Mundt1 , N. Bergemann1
  • 1Department of Psychiatry
  • 2Department of Neurology, Division of Neuroradiology, Ruprecht-Karls University, Heidelberg, Germany
Further Information

Publication History

Manuscript reveived: 2. 7. 1999 Revised: 4. 10. 2001

Accepted: 12. 11. 2001

Publication Date:
06 August 2002 (online)

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We report on the case of a 65-year-old female who was treated for one week with famotidine, a reversible H2-histamine antagonist, due to gastric pain. Shortly after treatment began, she presented manic symptoms and developed two generalized seizures, after which famotidine was discontinued. Manic symptoms were present for three months; intermittent treatment with both carbamazepine and antipsychotic medication was necessary before her mental status was completely restored. While cimetidine and ranitidine are known to cause secondary mania, this symptom has not been described for famotidine. CNS side effects are usually short-lived and respond to discontinuation of the drug, which was not the case in our patient. During a follow-up period that has so far lasted four years, the patient has been stable without any psychiatric medication.

Adjusting the maintenance dosage of H2-histamine antagonists has been recommended in elderly patients since age-related reduction in renal plasma flow, glomerular filtration rate and renal tubular function may be present, which can in turn elevate histamine levels in plasma and cerebrospinal fluid. Our patient, however, had normal renal function and was free of organic or psychiatric diseases, so what pathogenetic mechanism led to the remarkably long standing manic syndrome after a relatively short course of famotidine remained unknown; famotidine seems to cause the same spectrum of adverse central nervous system (CNS) reactions as other H2-histamine antagonists.

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Regina W. von Einsiedel, MD, PhD

Ruprecht-Karls-University of Heidelberg

Department of Psychiatry

Voßstr. 4

69115 Heidelberg

Germany

Phone: +49 (6221) 56-5462

Fax: +49 (6221) 56-5477

Email: regina_einsiedel@med.uni-heidelberg.de