When mania is not a mood disorder: drug interactions and cannabis use as a psychiatric risk factor in a liver transplant patient
DOI:
https://doi.org/10.25118/2763-9037.2025.v15.1523Keywords:
liver transplantation, mood disorders, mania, cannabis, immunosuppressive agents, drug interactionsAbstract
Introduction: Manic episodes in immunosuppressed patients after liver transplantation may have a multifactorial etiology, including drug interactions, use of psychoactive substances, and organic diseases. Objective: To describe a case of mania in a liver transplant recipient, suggesting a multifactorial etiology involving immunosuppressants, corticosteroids, and cannabis.Methods: Case report conducted after the patient signed the Informed Consent Form and approval by the Research Ethics Committee of Santa Casa de Porto Alegre Hospital (Ethics Opinion No. 7,889,261; CAAE 92291625.6.0000.5335), along with a narrative literature review. Results: A 56-year-old male patient developed a manic episode with delusions and agitation one month after liver transplantation while receiving tacrolimus, prednisone, antiretroviral therapy, and cannabis. The hypothesis of neurotoxicity induced by interaction between tacrolimus, corticosteroid therapy, and cannabis was raised after exclusion of infectious and neurological causes. An increase in serum tacrolimus levels was observed, suggesting interaction with cannabis. Treatment with mood stabilizers led to complete remission of symptoms. Conclusion: The interaction between cannabis, tacrolimus, and corticosteroids may contribute to acute neuropsychiatric effects. This case highlights the need for screening to identify potential drug interactions and for careful evaluation of cannabis use, with patient psychoeducation regarding associated risks.
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Copyright (c) 2025 Luiza Martins Barbosa Ceper, Bruna Ribas Ronchi, Lara Vitória Haubert , Tauãna Otarãn Savian, Marina Pimentel Beber de Guidali , Fernanda Martins Barbosa, Karen Regina Rosso Schons
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