PDF(Pubmed)
Abstract：
Gastric malabsorptive conditions may prevent patients from deriving benefit from orally administered medications intended for enteric absorption. While malabsorption is an increasingly common issue, current data on alternative oral options for agitation in these patients are very sparse. Sublingual (SL) asenapine is absorbed transmucosally, bypassing gut absorption, making it a viable consideration. We report on three patients, one with short bowel syndrome, one with viral gastritis, and one with aortic dissection who were trialed on SL asenapine for agitation after failing alternative antipsychotics. Two of these patients had an extensive history of psychiatric admissions for bipolar disorder and substance-induced psychosis. All three patients had significant reductions in agitation within 1-5 days, with no reported adverse effects. However, benefit of SL asenapine was hindered in two of these patients as they began inappropriately swallowing the medication, reducing bioavailability to nil. Clinicians should consider the use of SL asenapine for medically complex agitated patients where gastric absorption is questionable. There is an urgent need for guidelines on this matter, as well as more, alternative dosage forms for various medications that may help with agitation in this population.
摘要：
胃吸收不良状况可能会阻止患者从旨在用于肠吸收的口服药物中获得益处。虽然吸收不良是一个越来越普遍的问题，目前关于这些患者的躁动替代口服方案的数据非常稀少.舌下（SL）阿塞那平经粘膜吸收，绕过肠道吸收，使它成为一个可行的考虑。我们报道了三个病人,一个患有短肠综合征，一个是病毒性胃炎,以及一名患有主动脉夹层的患者，在替代抗精神病药失败后接受了SL阿塞那平的躁动试验。其中两名患者因双相情感障碍和物质诱发的精神病而有广泛的精神病入院史。所有三名患者在1-5天内躁动显著减少，没有报告的不良反应。然而,其中两名患者开始不适当地吞咽药物时，SL阿塞那平的益处受到阻碍，将生物利用度降低到零。临床医生应考虑将SL阿塞那平用于胃吸收可疑的复杂躁动患者。迫切需要就此事制定指导方针,以及更多,各种药物的替代剂型可能有助于该人群的躁动。
