Traino Amelia A, Buckley Nick A, Bassett Mark L
The Prince of Wales Hospital, Randwick, Sydney, Australia.
Ann Pharmacother. 2004 Dec;38(12):2068-70. doi: 10.1345/aph.1E011. Epub 2004 Nov 2.
To report a case of acute self-limiting ischemic colitis in a patient who was self-medicating with a proprietary over-the-counter oral decongestant containing pseudoephedrine.
A 46-year-old white man developed clinical, endoscopic, and histologic features of acute ischemic colitis after taking a proprietary oral decongestant containing pseudoephedrine 240 mg/day for one week. The total daily dose was at the upper limit of recommended doses for pseudoephedrine (as a single drug or in combination products). The patient was also taking tramadol 150 mg/day for chronic back pain. He made a complete recovery. There were no other explanations for the episode of ischemic colitis.
An objective causality assessment based on the Naranjo probability scale revealed pseudoephedrine to be a probable cause of ischemic colitis in our patient. Pseudoephedrine occasionally causes vascular insufficiency due to intense vasoconstriction, even at standard doses. Although our patient was not taking an excessive dose of pseudoephedrine, it is possible that the concurrent use of pseudoephedrine and tramadol may have increased adrenergic vasoconstriction, predisposing to ischemic colitis.
Prolonged or intensive use of medications containing pseudoephedrine should be avoided, and the package information should contain advice that the medication should be ceased if abdominal pain or other ischemic symptoms occur.
报告一例急性自限性缺血性结肠炎病例，该患者正在自行服用一种含有伪麻黄碱的非处方口服减充血剂。
一名46岁白人男性在连续一周每天服用240毫克含有伪麻黄碱的非处方口服减充血剂后，出现了急性缺血性结肠炎的临床、内镜及组织学特征。每日总剂量处于伪麻黄碱推荐剂量的上限（作为单一药物或复方制剂）。该患者还因慢性背痛每天服用150毫克曲马多。他完全康复。缺血性结肠炎发作没有其他原因。
基于Naranjo概率量表进行的客观因果关系评估显示，伪麻黄碱可能是我们这位患者缺血性结肠炎的病因。即使在标准剂量下，伪麻黄碱偶尔也会因强烈的血管收缩导致血管功能不全。虽然我们的患者服用的伪麻黄碱剂量并未过量，但同时使用伪麻黄碱和曲马多可能增加了肾上腺素能血管收缩，从而引发缺血性结肠炎。
应避免长期或大量使用含有伪麻黄碱的药物，药品包装信息应包含如下建议：如果出现腹痛或其他缺血症状，应停止用药。
