Traub Stephen J, Nelson Lewis S, Hoffman Robert S
New York City Poison Control Center, New York, USA.
J Toxicol Clin Toxicol. 2002;40(6):781-7. doi: 10.1081/clt-120015839.
Gamma-hydroxybutyrate is a potent sedative-hypnotic agent and a popular drug of abuse. In the United States, gamma-hydroxybutyrate is a Schedule I controlled substance (sodium oxybate) with orphan drug status for the treatment of narcolepsy within approved clinical studies. Physostigmine is a carbamate inhibitor of acetylcholinesterase that is reported to attenuate the sedative effects of a number of drugs, including gamma-hydroxybutyrate. We reviewed the literature that pertains to the use of physostigmine to treat gamma-hydroxybutyrate-induced sedation.
A structured literature search was performed to identify articles in which physostigmine and gamma-hydroxybutyrate were mentioned. Keywords were used to identify relevant articles in the Medline database, and the reference sections of articles identified by this method were hand-checked to identify additional articles. Those articles that presented original evidence pertaining to the use of physostigmine to treat gamma-hydroxybutyrate-induced sedation were included in this review; those that did not were rejected.
The literature search identified 22 articles, six of which did not pertain to the subject matter. Of the 16 articles which remained, 12 were rejected because they offered opinions without presenting original evidence. Of the four articles that presented original evidence, there were no in vitro studies and no animal studies. There were two small case series in which physostigmine was given to treat acute gamma-hydroxybutyrate toxicity in an emergency department setting, and two larger series in which physostigmine was given to attenuate the sedation induced by gamma-hydroxybutyrate in a more structured anesthesia setting. Although these references report that physostigmine attenuates gamma-hydroxybutyrate-induced sedation, there are methodological flaws and confounding factors that limit the scope of the conclusions that can be drawn from them.
There is currently insufficient scientific evidence to support the routine use of physostigmine in the treatment of gamma-hydroxybutyrate toxicity. Further studies are needed to determine the role, if any, for physostigmine in this setting.
γ-羟基丁酸是一种强效镇静催眠剂，也是一种常见的滥用药物。在美国，γ-羟基丁酸是一种第一类管制物质（羟丁酸钠），在批准的临床研究中具有用于治疗发作性睡病的孤儿药地位。毒扁豆碱是一种乙酰胆碱酯酶的氨基甲酸酯抑制剂，据报道可减轻包括γ-羟基丁酸在内的多种药物的镇静作用。我们回顾了有关使用毒扁豆碱治疗γ-羟基丁酸引起的镇静作用的文献。
进行了结构化文献检索，以识别提及毒扁豆碱和γ-羟基丁酸的文章。使用关键词在Medline数据库中识别相关文章，并对通过这种方法识别的文章的参考文献部分进行人工检查，以识别其他文章。本综述纳入了那些提供了有关使用毒扁豆碱治疗γ-羟基丁酸引起的镇静作用的原始证据的文章；那些没有提供的文章被排除。
文献检索识别出22篇文章，其中6篇与主题无关。在剩下的16篇文章中，12篇因仅提供观点而未提供原始证据被排除。在提供原始证据的4篇文章中，没有体外研究和动物研究。有两个小病例系列，在急诊科环境中给予毒扁豆碱治疗急性γ-羟基丁酸毒性，还有两个较大的系列，在更结构化的麻醉环境中给予毒扁豆碱减轻γ-羟基丁酸引起的镇静作用。尽管这些参考文献报告毒扁豆碱可减轻γ-羟基丁酸引起的镇静作用，但存在方法学缺陷和混杂因素，限制了从中得出的结论的范围。
目前没有足够的科学证据支持常规使用毒扁豆碱治疗γ-羟基丁酸毒性。需要进一步研究以确定毒扁豆碱在这种情况下的作用（如果有的话）。
