For professionals, hallucinations are not a typical effect of combining these medications
The former president said in a custody hearing this Sunday (23) that he had a “hallucination” and a “certain paranoia” that motivated the attempt to break the electronic ankle bracelet with a soldering iron on Friday night (21). Bolsonaro attributed his attitude to medications he was taking: pregabalin and sertaline.
According to the drug leaflets, pregabalin is an anticonvulsant used to treat anxiety and sertraline is an antidepressant.
The psychiatrist at Hospital Alemão Oswaldo Cruz, Dr. Flávia Zuccolotto explains that the association between the two medications is common in clinical practice and, in general, is safe when prescribed and monitored by a doctor:
“There is no recognized serious interaction between them. The main sum of effects usually occurs in increased drowsiness, reduced attention and psychomotor slowness, especially at the beginning of treatment or during dose adjustments”, he analyzes.
The doctor also emphasizes that any change or combination of medications must be guided by a healthcare professional.
Side effects
According to the medicine leaflets, the most common side effects of pregabalin are dizziness, drowsiness, weight gain, blurred or double vision, swelling, dry mouth, difficulty concentrating and paying attention.
And those of sertraline are: nausea, diarrhea, indigestion, loss of appetite, increased sweating, tremors and sexual dysfunction, hyperactive behavior and agitation.
For Dr. Flávia Zuccolotto, hallucinations are not a typical effect of this combination “they are very rare effects of both sertraline and pregabalin, individually or together”. However, changes in sense perception and mental confusion can occur rarely:
“Especially in high doses, at the beginning of treatment, in people with previous neurological or psychiatric vulnerability or using other substances that depress the central nervous system. In other words, it can happen, but it is uncommon and is not considered a direct effect of the combination of medications.”
According to the professional at Hospital Oswaldo Cruz, the signs and behavior of a person who is experiencing hallucinations are:
“They can be auditory (hearing voices), visual (seeing images or figures), tactile (sensations in the body), olfactory (perceiving non-existent odors), among others. And the intensity varies: some people are able to maintain certain activities, while others have more evident impairment. The person may appear distracted, talk to themselves, react to stimuli that do not exist, express fear, agitation or psychomotor slowness, in addition to demonstrating disorganization of thought and behavior”, he explains.
How medications work
According to the drug leaflet, pregabalin is an anticonvulsant that works by regulating the transmission of excitatory messages between nerve cells. It is indicated for the treatment of anxiety and chronic pain.
Sertraline is a selective serotonin reuptake inhibitor, used for depressive and anxious conditions.
According to the doctor, medications do not normally trigger psychotic episodes: “A psychotic episode is not a typical consequence of this drug combination. However, individuals with greater prior vulnerability may experience episodes of psychic acceleration that generate psychotic symptoms during the use of antidepressants such as sertraline. In rare cases, predisposed people may have some alteration in sensorial perception with high doses of pregabalin, but this does not characterize a classic psychotic condition”, he concludes.
Bolsonaro’s doctors suspend medication
Jair Bolsonaro’s (PL) medical team reported that the medication that allegedly caused mental confusion in the former president had been suspended. In the bulletin signed by general surgeon Claudio Birolini and cardiologist Leandro Echenique, the medication was prescribed by another doctor, with the aim of optimizing treatment, but without the team’s knowledge or consent.
“This medicine has an important interaction with the medicines he regularly uses to treat hiccups (Chlorpromazine and Gabapentin) and its recognized side effects include changes in mental state with the possibility of mental confusion, disorientation, abnormal coordination, sedation, balance disorders, hallucinations and cognitive disorders”, explain Birolini and Echenique.
“The medication was suspended immediately, with no residual symptoms at this time. The necessary adjustments were made to the medication, reestablishing the previous guidance”, they add.
The doctors also report that Bolsonaro “is stable from a clinical point of view and spent the night uneventfully” and say that they will continue to monitor the former president’s clinical evolution and carry out periodic reevaluations.
*With information from Estadão Conteúdo
Published by Nátaly Tenório
