Possible Association of Tremors and Dysarthria with Losartan Use: A Case Report

Some medications (epinephrine) that cause EPT likely lead to tremor by peripheral mechanisms in the muscle (β-adrenergic agonists), but others may influence the central component (amitriptyline). Other drugs can cause tremor, presumably by blockade of dopamine receptors in the basal ganglia (dopamine-blocking agents), by secondary effects such as causing hyperthyroidism (amiodarone), or by other mechanisms. We will attempt to discuss what is known and unknown about the pathophysiology of the most common MITs. In the latter stages of medical hospitalization for bath salt toxicity, once the autonomic storm has abated and reflexes and muscle tone have normalized, there may be a role for the use of antipsychotic medications. The synthetic cathinones are becoming notorious for their tendency to cause psychosis, dysphoria, and irritable unrest that extends beyond the duration of somatic toxicity.

Medical Conditions

No further psychosis was observed during his admission; he remained afebrile and hemodynamically stable. Elevated transaminase levels were attributed to a combination of hepatitis C infection and potential direct toxic effect of ingestion. Diagnosis of exposure to synthetic cathinones can be a challenge, as routine hospital enzyme-linked immunosorbent assay–based drug screening performed in most emergency departments will not detect these agents. Moreover, synthetic cathinones may result in a false-positive methamphetamine screen.

Severe Side Effects of High Blood Pressure Medications

The above case and discussion illustrates how a clinical triad of delirious agitation, autonomic instability, and hyperthermia (induced by sympathomimetic drug intoxication, specifically bath salts) can develop. While the above clinical triad can also be induced by a variety of toxidromes and urgent medical conditions, clinicians should be aware of the possibility of substance-induced etiologies even in the absence of a reliable history or clear toxicologic data. The emergence of synthetic cathinones under the street name bath salts represents an increasingly prevalent drug class of abuse, with observational studies and animal experiment data suggesting high addiction potential.

Who Is at Risk for Drug-Induced Tremors?

A pathophysiologic distinction between fever and hyperthermia may guide consideration of etiologies. Adrenergic excess, a consequence of toxicity from psychostimulants, serotonergic agents, and withdrawal from sedatives and ethanol, elevates metabolic indices and enhances neuromuscular activity (such that heat is generated). When endogenous cooling mechanisms are overwhelmed by the effects of monoamines on the cardiovascular and neuromuscular systems, the result can be an elevated body temperature. Since there is no primary driving force for heat generation in anticholinergic delirium, fever is mild and may be absent if environmental factors are not at play. As mentioned previously, resting tremor in DIP due to DBA can be asymmetric in many patients.2–5 Treatment of MIT due to DBA is aimed at reducing the dose of the offending drug or attempting to eliminate it completely. In many suspected DIP cases, however, treatment with DBA may unmask presynaptic dopamine deficiency due to an underlying Parkinsonian syndrome.58 In these patients, symptoms will continue and even progress after the DBA is withdrawn despite perhaps some initial improvement.

Drug-Induced Tremor

• These agents, which exert their therapeutic effects by blocking sodium channels, were commonly prescribed for many years, especially among acutely ill patients in intensive care settings.
• Certain medications can both cause tremors and worsen any tremors you already have from Parkinson’s disease or another similar disorder.
• If the first drug or combination doesn’t get your blood pressure down enough, even with dosage increases, another medication may be added.
• If you develop tremor — or an existing tremor gets worse — after starting a medication, tell your healthcare provider.
• Alpha-beta-blockers may cause a drop in blood pressure when you stand up suddenly or get up in the morning.
• The onset, timing, and severity of symptoms depend on the medication or drug that the patient is withdrawing from, the duration and severity of its use, and the baseline physiologic reserve of the patient.
• The movements look like trembling or shakiness and can range from mild to severe.

Lisinopril Side Effects Can Be LethalBlood pressure pills like Lisinopril are perceived as generally safe medications, but mysterious lisinopril side effects called angioedema can be life threatening. Tremor is a rhythmic movement of a body part that’s out of your control (involuntary). The movements look like trembling or shakiness and can range from mild to severe. Finally, it will be important to further define the most vital anatomical structures for the generation of tremor in the CNS and further understand the physiology of these interconnected players.

• His white blood cells (WBC) and red blood cells (RBC) were within normal limits and he did not present with any fever.
• Elevated transaminase levels were attributed to a combination of hepatitis C infection and potential direct toxic effect of ingestion.
• If you have problems with erections during sex, talk with your doctor.
• If you take a double dose by accident, you could get some extra side effects.
• This type of tremor is distinctive because it usually affects the hands, is more pronounced at rest, and is accompanied by a stooped posture and a shuffling walk.
• If a certain medication or substance (like caffeine or alcohol) is causing or worsening a tremor, stopping the medication (under your healthcare provider’s direction) or substance will likely help your symptoms.

Figure 1. Non-contrast computed tomography (CT) scan of the brain.

Gas chromatography–mass spectroscopy screening remains the gold standard for detection of active molecules in samples of urine and serum and would allow for a definitive diagnosis. As with most toxic presentations, however, laboratory testing is of limited diagnostic blood pressure medications that cause tremors value due to reporting delays; prompt recognition of the clinical toxidrome and aggressive management are of highest importance. One large study suggested that thiazide water pills (diuretics) have fewer side effects and work better on average than other drugs commonly prescribed as first treatments for high blood pressure. Immunosuppressants, which are used to prevent the rejection of transplanted organs, can also lead to drug-induced tremors. Drugs used to treat a variety of psychiatric disorders such as antipsychotics, lithium, and certain antidepressants are also potential causes of drug-induced tremors. Caffeine is a stimulant that can also cause you to have tremors or can worsen existing tremors.

Which High Blood Pressure Medications Have the Least Side Effects?

Angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) can cause harmful side effects for pregnant people and their developing babies. Never stop taking medication without first talking to your doctor. In some cases, this can be very dangerous, causing a big spike in blood pressure. Talk to your doctor about the medications you’re taking, and consult them before adding any new over-the-counter medications.