{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:12:50Z","timestamp":1753891970150,"version":"3.41.2"},"reference-count":15,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,10,18]],"date-time":"2023-10-18T00:00:00Z","timestamp":1697587200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pharmacol."],"abstract":"<jats:p>Extrapontine myelinolysis (EPM) is a rare symmetrical demyelinating disease of the central nervous system, which is often accompanied with central pontine myelinolysis (CPM) or can appear alone. A combination of flupentixol and melitracen is used as an antianxiety\u2013antidepressant drug which may induce hyponatremia. Herein, we report a 46-year-old woman with depression who was treated with flupentixol and melitracen 0.5\/10\u00a0mg once daily for 6\u00a0months. Later, the dosage increased to 0.5\/10\u00a0mg twice daily. At the same time, she had complains of intermittent dizziness and fatigue. The laboratory test revealed hyponatremia (121\u00a0mmol\/L). Dizziness was improved after sodium supplementation, with an increase in blood sodium to 133\u00a0mmol\/L. Twenty days later, she had difficulty opening the mouth and swallowing, needing a gastric tube due to severe dysphagia. Head magnetic resonance imaging (MRI) showed a symmetric abnormal signal of caudate nucleus and lenticular nuclei. The symptoms were not relieved after active treatment, such as rehydration. However, her symptoms improved significantly after discontinuation of flupentixol and melitracen and switching to promethazine. Follow-up head MRI after 4\u00a0months revealed no abnormal signals. The patient who developed EPM had dysphagia, despite appropriate correction of hyponatremia. Flupentixol and melitracen can cause hyponatremia and dysphagia. This case highlights an unexpected association between EPM and flupentixol- and melitracen-induced dysphagia.<\/jats:p>","DOI":"10.3389\/fphar.2023.1266296","type":"journal-article","created":{"date-parts":[[2023,10,18]],"date-time":"2023-10-18T08:29:12Z","timestamp":1697617752000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Case report: Extrapontine myelinolysis combined with flupentixol- and melitracen-induced dysphagia"],"prefix":"10.3389","volume":"14","author":[{"given":"Zhihong","family":"Zhao","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lu","family":"Han","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zilong","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2023,10,18]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"784","DOI":"10.4103\/0028-3886.72168","article-title":"Flupenthixol-induced tardive dystonia presenting as severe dysphagia","volume":"58","author":"Agarwal","year":"2010","journal-title":"Flupenthixol-induced tardive Dyst. Present. as Sev. dysphagia Neurol. India"},{"key":"B2","doi-asserted-by":"publisher","first-page":"936","DOI":"10.1111\/ped.13042","article-title":"Extrapontine myelinolysis associated with severe hypernatremia in infancy","volume":"58","author":"Aoki","year":"2016","journal-title":"Pediatr. Int."},{"key":"B3","first-page":"9348","article-title":"Deanxit can improve the dizziness, anxiety, and quality of life of patients with chronic subjective dizziness","volume":"13","author":"Chen","year":"2021","journal-title":"Am. J. Transl. Res."},{"key":"B4","doi-asserted-by":"publisher","first-page":"e15261","DOI":"10.1097\/MD.0000000000015261","article-title":"Acute parkinsonismas an unexpected consequence of pituitary adenoma resection: a case report","volume":"98","author":"Ho","year":"2019","journal-title":"Med. Baltim."},{"key":"B5","first-page":"310","article-title":"Dysphagia and severe hyponatremia duetoflupentixoland melitracen tablets in an elderly patient","volume":"14","author":"Hou","year":"2012","journal-title":"J. Adverse Drug React."},{"key":"B6","doi-asserted-by":"publisher","first-page":"1780","DOI":"10.4102\/sajpsychiatry.v27i0.1780","article-title":"Erratum: extrapyramidal side effects in first-episode schizophrenia treated with flupenthixol decanoate","volume":"27","author":"Joubert","year":"2021","journal-title":"S Afr. J. Psychiatr."},{"key":"B7","doi-asserted-by":"publisher","first-page":"600","DOI":"10.3238\/arztebl.2019.0600","article-title":"Central pontine myelinosis and osmotic demyelination syndrome","volume":"116","author":"Lambeck","year":"2019","journal-title":"DtschArztebl Int."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1481","DOI":"10.1097\/PRS.0000000000003329","article-title":"Selective serotonin reuptake inhibitor- induced hyponatremia and the plastic surgery patient","volume":"139","author":"Levine","year":"2017","journal-title":"Plast. Reconstr. Surg."},{"key":"B9","doi-asserted-by":"publisher","first-page":"iii22","DOI":"10.1136\/jnnp.2004.045906","article-title":"Central pontine and extrapontine myelinolysis: the osmotic demyelination syndromes","volume":"75","author":"Martin","year":"2004","journal-title":"J. Neurol. Neurosury Psychiatry"},{"key":"B10","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1136\/practneurol-2019-002347","article-title":"Central pontine (and extrapontine) myelinolysis despite appropriate sodium correction","volume":"20","author":"Micieli","year":"2020","journal-title":"Pract. Neurol."},{"key":"B11","doi-asserted-by":"publisher","first-page":"1443","DOI":"10.1111\/ene.12571","article-title":"Central pontine and extrapontine myelinolysis:a systematic review","volume":"21","author":"Singh","year":"2014","journal-title":"Eur. J. Neurol."},{"key":"B12","doi-asserted-by":"publisher","first-page":"320","DOI":"10.1007\/s00134-014-3210-2","article-title":"Clinical practice guideline on diagnosis and treatment of hyponatraemia","volume":"40","author":"Spasovski","year":"2014","journal-title":"Intenisve CareMed"},{"key":"B13","doi-asserted-by":"publisher","first-page":"559.e11","DOI":"10.1016\/j.genhosppsych.2010.01.012","article-title":"A case of schizophrenia with dysphagia successfully treated by a multidimensional approach","volume":"32","author":"Tang","year":"2010","journal-title":"Gen. Hosp. Psychiatry"},{"key":"B14","doi-asserted-by":"publisher","first-page":"101","DOI":"10.4068\/cmj.2018.54.2.101","article-title":"Addressing the side effects ofContemporary antidepressant drugs: a comprehensive review","volume":"54","author":"Wang","year":"2018","journal-title":"Chonnam Med. J."},{"key":"B15","doi-asserted-by":"publisher","first-page":"e15847","DOI":"10.1016\/j.heliyon.2023.e15847","article-title":"Melitracen and flupentixol (deanxit) use disorder in Lebanon","volume":"9","author":"Zahran","year":"2023","journal-title":"Heliyon"}],"container-title":["Frontiers in Pharmacology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphar.2023.1266296\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,18]],"date-time":"2023-10-18T08:29:16Z","timestamp":1697617756000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphar.2023.1266296\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,18]]},"references-count":15,"alternative-id":["10.3389\/fphar.2023.1266296"],"URL":"https:\/\/doi.org\/10.3389\/fphar.2023.1266296","relation":{},"ISSN":["1663-9812"],"issn-type":[{"type":"electronic","value":"1663-9812"}],"subject":[],"published":{"date-parts":[[2023,10,18]]},"article-number":"1266296"}}