A Case of Dysphagia That Improved after Discontinuation of Sulpiride Prescribed to Alleviate Anorexia

Abstract

　Introduction:　Sulpiride, an antipsychotic drug, is used in low doses as a stomachic and antidepressant and is sometimes prescribed to alleviate anorexia. However, there have been reports of dysphagia as an adverse effect of sulpiride, although the relationship between sulpiride dosage and dysphagia is not clear. In this study, we experienced a case of drug-induced dysphagia in an older patient, who was prescribed 150 mg/day of sulpiride to alleviate anorexia.

　Case:　An 88-year-old man was transferred to our hospital for rehabilitation after a cardiogenic stroke in his right occipital lobe. His swallowing function was judged to be normal by a repetitive saliva swallowing test (RSST) performed three times, and he had a modified water swallowing test (MWST) score of 5 (no thickening) on day 1 of hospital transfer. On day 21 after hospital transfer, the patient developed a fever and dysphagia. A cough test showed no cough, and a videoendoscopic examination of swallowing (VE) revealed saliva intrusion into the larynx. A videofluoroscopic examination of swallowing (VF) revealed decreased pharyngeal clearance and silent aspiration. After considering the advantages and disadvantages of sulpiride, the drug was discontinued. Two weeks later, a cough test showed coughing within 10 s, and the VE and VF showed improvement in swallowing function.

　Conclusions:　Sulpiride can cause drug-induced dysphagia, even at low doses, and may cause silent aspiration as an adverse effect, which should be diagnosed by a cough test, VE, and VF.