2019 Volume 52 Issue 8 Pages 485-489
A 67-year-old male patient with gout-induced end-stage renal disease had been receiving maintenance hemodialysis therapy for 35 years. He was admitted to our hospital because of visual hallucinations, disturbances of consciousness, involuntary movement, and inarticulation, and a cerebral infarction was suspected. Prior to developing these symptoms, he had been administered 0.125 mg/2 days digoxin and 40 mg/day aprindine hydrochloride (for heart failure with paroxysmal atrial fibrillation) for two weeks at another hospital. At our hospital, we switched him from hemodialysis to online hemodiafiltration because he exhibited intradialytic hypotension. His serum digoxin level was high (2.3 ng/mL). After the digoxin was stopped, the visual hallucinations, disturbances of consciousness, and involuntary movement resolved within two weeks. However, the inarticulation did not improve. Therefore, the patient’s serum aprindine hydrochloride level was measured. It was found to be high (3.02 μg/mL). Thus, the aprindine hydrochloride dose was reduced to 30 mg/day. The patient’s symptoms improved significantly. It is necessary to pay attention to the side effects of aprindine hydrochloride, even in patients with appropriate serum aprindine hydrochloride levels.
