Reactions 833 - 6 Jan 2001

Quinapril

Hallucinations, paranoid delusions, confusion andanxiety in an elderly patient: case report

Quinapril for congestive heart failure was associated withvisual hallucinations, paranoid delusions, confusion andanxiety in a 93-year-old woman. She had experienced anepisode of hallucinations associated with β-blocker therapyapproximately 2 years earlier.

Two hours after quinapril 2.5mg twice daily was added tothe woman’s extensive treatment regimen, she developedconfusion and disorientation, and she became anxious. Duringthat night, she experienced visual hallucinations; she mademany telephone calls to family members stating that she wasbeing assaulted.

Four days after starting quinapril, the agent was stopped. Bythat evening the woman had become less disoriented andparanoid, but she remained somewhat confused and she haddifficultly sleeping. During the next day, she became fullyoriented and did not experience any further hallucinations.

Author comment: ‘The pharmacokinetics and lipophilicproperty of quinapril support the feasibility of its provoking theobserved central nervous system effects. The onset of action is 1hour, peak effect is within 2 to 4 hours, and duration of action isup to 24 hours, all temporally consistent with the initiation andcessation of the patient’s symptoms’.Tarlow MM, et al. Quinapril-associated acute psychosis in an older woman.Journal of the American Geriatrics Society 48: 1533, Nov 2000 -USA 800853555

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Reactions 6 Jan 2001 No. 8330114-9954/10/0833-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved