Propiverine induced pure visual hallucinations without cognitive impairment: A case report

Rationale: Propiverine is believed to have fewer adverse effects on the central nervous system than other anticholinergic medications since it penetrates the blood–brain barrier less deeply. In daily practice, no evidence links propiverine use to neuropsychiatric adverse effects. To our knowledge, this is the first report of psychotic symptoms being linked to propiverine use. Patient concerns: A urologist prescribed 30 mg/day of propiverine capsules to a 62-year-old male patient who complained of urine incontinence and visited the urology outpatient clinic. The patient returned to the urology outpatient clinic a week later because he was experiencing visual hallucinations. Interventions: In the psychiatry outpatient clinic, the patient was conscious, cooperative, and oriented during the mental state examination. He spoke about daylong visual hallucinations that included visions of numerous animals and geometric forms. His mood was somewhat anxious as a result of these images, which started appearing 3 days after taking the propiverine capsule and persisted for 4 days. His cognitive functions were normal. Physical examination, blood chemistry, endocrinology, and brain exams using cranial tomography and electroencephalogram revealed no abnormalities. We advised stopping the medication since visual hallucinations started soon after taking propiverine capsules. Outcomes: After discontinuation of propiverine capsules, the patient’s visual hallucinations disappeared. Lessons: Health practitioners should be aware that adverse effects like visual hallucinations can happen even with anticholinergic medications like propiverine that have a low level of penetration into the blood–brain barrier.