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Oseltamivir and Neuropsychiatric Behaviors – A Case Report on an Adolescent Teen and Evaluation of the Literature

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Author(s): Tsz-Yin SO | Suresh NAGAPPAN

Journal: Journal of Pediatric Sciences
ISSN 1309-1247

Volume: 1;
Date: 2009;
Original page

Keywords: oseltamivir | neuropsychiatric | pediatric | influenza

ABSTRACT
OBJECTIVE: To illustrate a case of oseltamivir induced neuropsychiatric behaviors in an adolescent teen. CASE SUMMARY: A 15-year-old previously healthy adolescent presented to the emergency department with acute onset of altered mental status after taking two doses of oseltamivir prescribed to him by his primary care physician for presumed influenza infection. A thorough examination at the hospital, which included a urine drug screen, complete blood count, complete metabolic panel, urine and blood cultures, head computed tomography, and chest radiograph, did not indicate any other clinical conditions that could explain his abnormal behaviors. No other medications were given to him in the hospital. About 20 hours after the last dose of oseltamivir, he awoke from a nap and his mental status was completely back to baseline. He had no memory of the events transpired in the past 24 hours and was discharged home with no further incidence.DISSCUSION: Oseltamivir is an anti-viral agent that is often used as treatment and prophylaxis for influenza infection. Neuropsychiatric adverse events such as hallucination and delirium can potentially occur with this agent. This rare adverse event may be due to the binding of the medication to the enzyme sialidase causing increase in dopamine activity. Most of the reports were in young Japanese children less than 16 years old. Some studies have shown a causal relationship with oseltamivir leading to this adverse event, while some have failed to do so, probably due to flaws in their analytical method. The Naranjo ADR probability scale showed a possible causality between neuropsychiatric behaviors and oseltamivir administration in this patient.CONCLUSIONS: Oseltamivir is an effective anti-viral for influenza infection if started early in the course of the illness. Clinicians should monitor for neuropsychiatric symptoms when starting patients on this medication.
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