Hallucination procaine

Procainamide, unlike procaine, has little potential to produce CNS toxicity. Rarely, patients may be confused or have hallucinations. 

It has long been known that intramuscular procaine penicillin can cause some peculiar psychological adverse reactions, and that other penicillin derivatives, such as amoxicillin, can cause psychiatric reactions, such as hallucinations (SEDA-21, 259). In a report from the Netherlands, neuropsychiatric symptoms occurred in six patients who received cefepime for febrile neutropenia (147). The patients, two men and four women, aged 32-75 years, received 6 g/day (n = 5) or 3 g/day (n = 1). 

In contrast to hypersensitivity, other adverse reactions do not require sensitization and require similar doses of drug for recurrence. A special case is a syndrome (Hoigne s syndrome) that resembles an immediate allergic reaction combined with hallucinations, aggressive behavior, anxiety, and auditory and visual disturbances, which has been described after intramuscular procaine penicUhn and benzathine penicillin. It is probably due to accidental intravascular injection and results from micro-embohsm of the penicUhn depot formulation (271-275). 

See Procaine derivatives Mania or hypomania Delirium, hallucinations, paranoia, mania See Benzodiazepines See Thiazides See Atropine and Anticholinergics Psychosis, depression, disorientation, hallucinations, delusions... 

A peculiar neuropsychiatric reaction to intramuscular injection of procaine penicillin comprises fear of death and auditory and visual hallucinations. A widely supported theory claims that this so called Hoigne syndrome is an embolic-toxic reaction, but recent findings strongly suggest that free procaine, liberated in vivo, is responsible. In one study, 26 patients received 4.8 million units of procaine penicillin i.m. Immediately after injection the plasma procaine levels amounted to 6.6 ixglraX (3.6-11 /ug/ml) and dropped quickly to less than 1 jUg/ml in all cases within 30 minutes. One of these patients experienced auditory and visual hallucinations his zero-time level of procaine was 9.5 jug/ml. The observation that the same symptoms can be elicited by intravenous injection of procaine and also that the time sequence of the plasma procaine levels and of the symptoms coincide (since the latter too disappear in 30 minutes) clearly indicate procaine as the causative factor (13, W -). 

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