Vol. 8, Issue 8, Part A (2022)

Abstract
Hyperactivation of protein kinase C (PKC) signaling is seen among patients with bipolar I disorder (BPD-I). Direct PKC inhibition can help in the faster remission of symptoms and reduce the chances of hospitalizations. Endoxifen, a direct inhibitor of the PKC signaling pathway, is safe and effective in controlling acute mania and mixed episodes of BPD-I at a dosage strength of 8 mg. Here we present the case of a patient with severe BPD-I mania with moderate psychotic features treated with endoxifen at a daily dose of 8 mg and paliperidone adjunctive therapy for 4 months. Treatment with endoxifen was efficacious in controlling manic and psychotic symptoms with no incidences of drug-induced tremors, weight gain, and metabolic disturbances. Endoxifen plus paliperidone antipsychotic therapy was economical as compared to lithium–olanzapine combination therapy due to no serious inpatient hospitalization. Endoxifen was well tolerated, and the patient resumed work at the end of 4 months. This case showed the safety and cost-effectiveness of endoxifen therapy in managing severe psychotic BPD-I disease.