Clinical evidence,mechanism, importance and management
A man with a schizoaffective disorder taking lorazepam,orphenadrine, fluvoxamine and fluphenazine decanoate 12.5mg every 2 weeks, developed acute and painful dystonia of trunk, neck, right arm and leg about one week after his last fluphenazine injection and on fourth day of taking spiramycin 6 million units daily for gingivitis. The problem resolved when he was given biperiden (See reference number 1). The reasons for this adverse reaction are not understood, nor is it entirely clear whether this was an interaction between fluphenazine and spiramycin, although author suggested that a causal link existed. This seems to be only report of an alleged interaction between fluphenazine and a macrolide antibacterial and it is therefore of little or no general importance.
1. Benazzi F. Spiramycin-associated acute dystonia during neuroleptic treatment. Can J Psychiatry (1997) 42,665–6.