IMMEDIATE NONALLERGIC PSYCHOTIC REACTION TO INTRAMUSCULAR PROCAINE PENICILLIN

Background. Though little known by medical personnel, an immediate non allergic psychotic reaction to intramuscular procaine penicillin has b een reported occasionally from many countries since 1951. Materials an d Methods. A case report describes a patient whose Violent behavior, p rovoked by this reaction, resulted in legal action taken against him. Two other nonviolent cases are presented and are followed by a review of the literature. Results. Signs and symptoms of this reaction that a ppears to be to the procaine component resemble a presser response and are therefore contrary to the signs and symptoms of an anaphylactic r eaction. Anxiety, hallucinations, hypertension, and tachycardia are ch aracteristic. The reaction is self-limited, Long-term psychologic sequ elae might be averted by adequate reassurance. Conclusions. The import ance of procaine penicillin as an essential drug in many parts of the world should not be diminished; however, recognition of acute nonaller gic psychotic reactions is of paramount importance to assure proper pa tient management and to avoid misinterpretation of aggressive behavior .