長期にわたるオランザピンの筋肉内注射による注射後の妄想/鎮静症候群は,フィソスティグミンおよびリバスティグミンで迅速に逆転する
Sally Fotheringham1, Nicholas A Buckley1, Camilla Bradshaw2
1Drug Health and Toxicology Unit, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
Clinical toxicology (Philadelphia, Pa.)
|September 1, 2025
まとめ
オランザピンは,アセチルコリネステラス阻害剤で効果的に治療できます. フィソスティグミンは快速に妄想を解消し,リバスティグミンは再発を防止し,第一線アプローチを示唆した.
科学分野:
- 薬理学について
- 神経科学
- 臨床医学
背景:
- 投薬後の妄想/鎮静症候群 (PDSS) は,デポオランザピンの希少だが深刻な副作用である.
- 現在の治療は通常 サポートケアとベンゾジアゼピンで 効果的でない場合もあります
研究 の 目的:
- 長期にわたるオランザピンの筋肉内デポ投与後のPDSSの2例を報告する.
- PDSSの管理におけるアセチルコリネステラゼ阻害剤 (フィソスティグミンとリバスティグミン) の有効性を記述する.
主な方法:
- オランザピンを放置した後にPDSSを発症した2人の患者の症例報告
- 静脈内フィソスティグミン投与後,経皮リヴァスティグミンの維持療法を行います.
- 妄想症状とオランザピンの血濃度のモニタリング
主要な成果:
- 両方の患者はフィソスティグミン投与後数分以内に快速な妄想を体験した.
- 皮膚経由のリバスティグミンは症状の再発を効果的に予防しました.
- フィソスティグミンは,通常使用される抗ムスカリン妄想よりも低い用量で有効でした.
- 一人の患者ではオランザピンの血濃度の上昇が認められた.
結論:
- PDSSは,アセチルコリネステラゼ阻害剤に反応する抗ムスカリンメカニズムを含んでいるようです.
- 早期のフィソスティグミンとリバスティグミンは,PDSSの高度に効果的な標的治療法である.
- アセチルコリネステラス阻害剤は,PDSSにおける抗ムスカリン性妄想の第一線治療として考慮されるべきである.
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