頁籤選單縮合
題名 | Serotonin Toxicity Caused by Moclobemide Too Soon After Paroxetine-Selegiline=併用Moclobemide、Paroxetine和Selegiline引起神經激胺毒性 |
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作 者 | 吳明玲; 鄧昭芳; | 書刊名 | Journal of the Chinese Medical Association |
卷期 | 72:8 2009.08[民98.08] |
頁次 | 頁446-449+CA83 |
分類號 | 418.2 |
關鍵詞 | 藥物交互作用; 單胺氧化酶抑制劑; 選擇性神經激胺再吸收抑制劑; 神經激胺毒性; Drug interaction; Monoamine oxidase inhibitor; Selective serotonin reuptake inhibitor; Serotonin toxicity; |
語文 | 英文(English) |
英文摘要 | Serotonin toxicity is an iatrogenic complication of serotonergic drug therapy. It is due to an overstimulation of central and peripheral serotonin receptors that lead to neuromuscular, mental and autonomic changes. Moclobemide is a reversible inhibitor of monoamine oxidase (MAO)-A, selegiline is an irreversible selective inhibitor of MAO-B, and paroxetine is a selective serotonin reuptake inhibitor. Combined use of these agents is known to cause serotonin toxicity. A 53-year-old woman had been treated with paroxetine and selegiline. After moclobemide was prescribed in place of paroxetine without a washout period, she quickly developed confusion, agitation, ataxia, diaphoresis, tremor, mydriasis, ocular clonus, hyperreflexia, tachycardia, moderately elevated blood pressure and high fever, symptoms that were consistent with serotonin toxicity. Discontinuation of the drugs, hydration and supportive care were followed by remarkable improvement of baseline status within 3 days. This case demonstrates that serotonin toxicity may occur even with small doses of paroxetine, selegiline and moclobemide in combination. Physicians managing patients with depression must be aware of the potential for serotonin toxicity and should be able to recognize and treat or, ideally, anticipate and avoid this pharmacodynamicallymediated interaction that may occur between prescribed drugs. |
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