Familial liability for metoprolol-induced psychosis

Abstract Objective : Beta-blockers are commonly used in the treatment of hypertension and cardiac arrhythmias. The incidence of neuropsychiatric side effects is generally low. This case report shows the potential familial liability of a metoprolol-induced psychosis. Method : We report a case of meto...

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Bibliographic Details
Published in:General hospital psychiatry 2015-11, Vol.37 (6), p.620.e5-620.e6
Main Authors: Rietveld, L., M.D, van der Hoek, T., M.D, van Beek, M.H.C.T., M.D, Schellekens, A.F.A., M.D., Ph.D
Format: Article
Language:English
Subjects:
Adrenergic beta-1 Receptor Antagonists - adverse effects
Adult
Beta blockers
Cytochrome P-450 CYP2D6 - genetics
Familial
Genetic Predisposition to Disease
Humans
Male
Metoprolol
Metoprolol - adverse effects
Psychiatry
Psychoses, Substance-Induced - genetics
Psychosis
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Summary:Abstract Objective : Beta-blockers are commonly used in the treatment of hypertension and cardiac arrhythmias. The incidence of neuropsychiatric side effects is generally low. This case report shows the potential familial liability of a metoprolol-induced psychosis. Method : We report a case of metoprolol-induced psychosis. Potential pharmocogenetic factors mediating this familial metoprolol-induced psychosis are discussed. Results : A middle-aged man developed psychosis after starting metoprolol, which diminished after ceasing the medication. Two of his family members experienced similar symptoms after using metoprolol. All family members were genotyped as CYP2D6*4 allele carriers indicating reduced CYP2D6 enzyme activity. Conclusion : The case presented here suggests a potential familial liability for metoprolol- induced psychosis. Pharmacokinetic mechanisms are hypothesized to mediate this familial liability through genetic variation in the CYP2D6 genotype. A family history of psychotic symptoms after treatment with beta-blockers should be taken into account, when prescribing this beta-blocker.
ISSN:0163-8343
1873-7714
DOI:10.1016/j.genhosppsych.2015.06.016