Caution is required when prescribing antidepressants like amoxapine to patients with chronic renal failure on hemodialysis due to the risk of fatal neuroleptic malignant syndrome.
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Amoxapine may trigger fatal NMS in hemodialysis patients; this single case leaves open broader risk assessment.
A 63-year-old man with chronic renal failure who had received hemodialysis three times per week for 4 years developed neuroleptic malignant syndrome 10 days after taking amoxapine. His condition was characterized by muscle rigidity, elevation of body temperature and altered consciousness. Although he was treated with dantrolen and supportive care as well as discontinuation of amoxapine, his condition rapidly deteriorated, resulting in death. Because the pharmacokinetics of drugs, especially those such as antidepressants, in patients with chronic renal failure has not been fully clarified, one should be careful about giving such patients these drugs.
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Kunishima et al. (2000) studied this question.
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