Severe nightly hypotension with combination of antihypertensive medication and prothipendyl

A 77 year old demented female with known arterial hypertension received 80 mg prothipendyl at 8 p. m. for sleep cycle regulation from the day of admission to a geriatric psychiatric ward. At first there seemed to be no adverse reactions. One week after adding amlodipine to the antihypertensive medication of ramipril, bisoprolol and hydrochlorothiazide because of arterial pressure of up to 260 mm Hg, she showed symptoms of disturbed cerebral perfusion with severe arterial hypotension of 60/40 mm Hg at 10 p. m., although daytime blood pressure measurements still yielded mostly hypertensive results. Satisfactory blood pressure regulation could only be achieved after prothipendyl was replaced by melperone. This case was registered by the AMSP (Arzneimittelsicherheit in der Psychiatrie - Drug Safety in Psychiatry) project and sheds light on the special problems of treating disorders of the sleep-wake-cycle with substances that have potential hypotensive side effects. Circadian sleep disorder of the irregular type is a frequent indication for geriatric psychiatric inpatient treatment of demented patients.