在接受RISPERIDONE和TRAZODONE治疗的患者中,多尼佩西尔诱导的神经性恶性综合征
Hiroaki Nishioka1, Wataru Kaita2
1General Internal Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan nishiokahiroaki@hotmail.com.
BMJ case reports
|April 22, 2025
概括
神经乱性恶性综合征 (NMS) 是一种罕见但严重的反应,可以由阿尔茨海默病药物多内佩西尔 (donepezil) 引发. 这一案例突出了巴西所做的事情.
科学领域:
- 药理学 药理学是指药理学的学科.
- 神经学 神经学
- 老年病的医生 老年病的医生
背景情况:
- 神经乱性恶性综合征 (NMS) 是一种罕见的,危及生命的不良药物反应,主要与抗精神病药物有关.
- 用于阿尔茨海默病的乙胆酶抑制剂多尼佩西尔 (donepezil) 很少与NMS有关.
- 同时使用抗精神病药物和乙胆酶抑制剂可能会增加NMS的风险.
研究的目的:
- 报告在老年患者中罕见的NMS病例,该病例始于donepezil.
- 调查多尼佩西尔在单独或与其他精神药物结合的NMS沉中的潜在作用.
主要方法:
- 一个老年男性患者的病例报告呈现出暗示NMS的症状.
- 审查患者的药物 anamnesis,包括最近启动和donepezil的剂量升级.
- 临床评估,实验室调查 (包括肌酸激酶水平) 和对治疗的反应.
主要成果:
- 患者在开始服用多尼佩西尔并增加剂量后出现了经典的NMS症状 (发烧,肌肉硬,精神状态改变).
- 肌酸激酶水平升高证实了与NMS相一致的肌肉分解.
- 患者在停止多尼佩西尔和支持性护理后迅速康复;在恢复之前的抗精神病和抗抑郁药物时,NMS没有复发.
结论:
- 多尼佩西尔可以诱导神经乱性恶性综合征,即使在患有先前精神疾病的老年患者中也是如此.
- 这一案例强调了考虑多尼佩西尔作为NMS潜在触发因子的重要性,特别是当与抗精神病药物联合使用时.
- 临床医生应在开始或调整donepezil治疗的患者中保持对NMS的高度怀疑指数.
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