目的:已经发表了几例由金刚烷胺中毒引起的中枢神经系统(CNS)症状的病例报告,详细说明各种类型的症状和不同的发病时间。我们遇到了一名患者,该患者出现了金刚烷胺的中枢神经系统症状。这促使我们调查类型,发病时间,通过分析药物警戒数据库中的数据,以及对金刚烷胺的中枢神经系统不良反应的结果。
方法:患者在楚托恩总医院接受评估,静冈,日本。使用日本不良药物事件报告(JADER)数据库进行分析。
结果:在我们的案例中,金刚烷胺的血药浓度为4042ng/ml,即,在有毒范围内。运动障碍的发病时间为26天,意识水平降低的发病时间为90天。停药金刚烷胺后症状缓解。JADER数据库包含974例金刚烷胺不良反应。最常报告的中枢神经系统不良反应是幻觉,报告比值比为64.28(95%置信区间=52.67-78.46)。检测到所有CNS不良反应的阳性信号。对于所有中枢神经系统反应,在相对较低比例的病例中,临床结局较差.大多数中枢神经系统反应发生在服用金刚烷胺后不久,通常在一个月内。
结论:因为金刚烷胺的大多数中枢神经系统不良反应通常发生在开始治疗的大约一个月内,在此期间,医疗保健提供者应高度警惕监测患者的此类反应。
OBJECTIVE: A few case reports of central nervous system (CNS) symptoms caused by amantadine intoxication have been published, detailing various types of symptoms and differing times to onset. We encountered a patient who developed CNS symptoms with amantadine. This prompted us to investigate the types, time to onset, and outcome of CNS adverse reactions to amantadine by analyzing data from a pharmacovigilance database.
METHODS: The patient was evaluated at Chutoen General Hospital, Shizuoka, Japan. Analysis was performed using the Japanese Adverse Drug Event Report (JADER) database.
RESULTS: In our case, the amantadine blood concentration was 4,042 ng/ml, i.e., in the toxic range. The time to onset was 26 days for dyskinesia and 90 days for depressed level of consciousness. Symptoms resolved when amantadine was discontinued. The JADER database contained 974 cases of adverse reactions to amantadine. The most frequently reported CNS adverse reaction was hallucination, with a reporting odds ratio of 64.28 (95% confidence interval=52.67-78.46). Positive signals were detected for all CNS adverse reactions. For all CNS reactions, clinical outcomes were poor in a comparatively low percentage of cases. Most CNS reactions occurred soon after administration of amantadine, usually within approximately one month.
CONCLUSIONS: Because most CNS adverse reactions to amantadine usually occur within approximately one month of initiating treatment, healthcare providers should exercise heightened vigilance in monitoring patients for such reactions during this period.