Clonazepam-Induced Acute Itch

Prim Care Companion CNS Disord 2023;25(3):22cr03351

To cite: Hafi B, Uvais NA. Clonazepam-induced acute itch. Prim Care Companion CNS Disord. 2023;25(3):22cr03351.
To share: https://doi.org/10.4088/PCC.22cr03351

© 2023 Physicians Postgraduate Press, Inc.

^aDepartment of Dermatology, Iqraa International Hospital and Research Centre, Calicut, Kerala, India
^bDepartment of Psychiatry, Iqraa International Hospital and Research Centre, Calicut, Kerala, India
*Corresponding author: N. A. Uvais, MBBS, DPM, Iqraa International Hospital and Research Centre, Malaparamba, Calicut, Kerala, 673009, India (druvaisna@gmail.com).

Clonazepam is one of the most frequently prescribed and well-tolerated benzodiazepines for the management of seizures and anxiety spectrum disorders. Cutaneous side effects with clonazepam use have rarely been reported in the literature. Clonazepam has been shown to induce the following dermatologic conditions: lichenoid drug eruption, maculopapular rash, bullous dermatosis, eczematous drug eruption, erythema multiforme, pseudo-mycosis fungoides, localized exfoliating eruptions, and alopecia.^1–3

Generalized itching without apparent skin lesions caused by a drug is called drug-induced itch. Among the anxiolytic medications, diazepam, nitrazepam, and oxazepam have been reported to induce itch.⁴ Although a variety of cutaneous adverse effects have been reported with clonazepam, drug-induced itch as an isolated side effect has not yet been reported. Here, we report a case of a 22-year-old male patient with depressive disorder who developed drug-induced itch while taking clonazepam.

Case Report

A 22-year-old man presented with his mother to the outpatient psychiatric department of our hospital with psychiatric symptoms of 1 month duration, characterized by low mood, worries, reduced interest, lack of joy in previously enjoyable activities, difficulties in concentration, and reduced appetite and sleep. The symptoms were precipitated by issues with family over his relationship with a girl, which family members were not ready to accept. There was no past or family history of psychiatric illness. There were no medical comorbidities. There was no history of drug allergies. Mental status examination revealed depressed affect and depressive cognition. He was diagnosed with moderate depressive episode according to ICD-10 criteria and started on oral sertraline 50 mg/d, which was gradually increased to 100 mg/d over 1 month, and oral clonazepam 0.25 mg/d. During the follow-up visit after 4 weeks, he reported significant improvements in depressive symptoms. However, he also reported generalized itching all over his body. There was no other systemic illness. Drug-induced pruritus was considered, and clonazepam was stopped. The patient improved within 5 days with no recurrence of itch. He is currently maintained well on sertraline.

Discussion

We report an unusual side effect of clonazepam in a young man that was acute in nature (< 6 weeks), and as with other instances of acute drug-induced itch, it improved with cessation of the culprit drug. The pathophysiologic mechanism of drug-induced itch is largely unknown except for a few specific drugs that cause it.⁵

Itch is an unpleasant cutaneous sensation that leads to intensive scratching, resulting in poor drug compliance. Of hundreds of etiologies of itch, drug-induced pruritus is especially important because of its avoidable nature. Treatment of drug-induced itch is not complete without cessation of the suspected drug. Hence, it is important to report each case of drug-induced itch, or other adverse drug reactions, for larger interests of the medical fraternity.

Published online: May 16, 2023.
Relevant financial relationships: None.
Funding/support: None.
Patient consent: Consent was received from the patient to publish the case report, and information has been de-identified to protect anonymity.