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
