Thomas A, Nallur D G, Jones N, Deslandes P N
Community Addictions Unit, Cardiff, UK.
J Psychopharmacol. 2009 Jan;23(1):101-5. doi: 10.1177/0269881107083809. Epub 2008 Feb 28.
Many medicines available over the counter from pharmacies are known to have abuse potential, including diphenhydramine (DPH), an antihistamine with antimuscarinic properties used for the treatment of insomnia. We present a brief review of the literature describing DPH abuse, and report the case of GF, a 56 year old woman who was admitted to an inpatient addictions unit for detoxification from DPH. A literature search revealed five case reports of DPH abuse including a total of six patients, published between 1986 and 2001. All reported cases exhibited features of DSM-IV criteria for substance dependence, and there was an apparent link with antipsychotic usage. GF was treated with antipsychotics, and was using up to thirty 50 mg DPH tablets each day. She described feeling 'good and calm' and 'it stopped the tremors'. GF tolerated a gradual dose reduction schedule, and completed the detoxification programme relatively comfortably. She was discharged from the inpatient detoxification unit as planned, and had not relapsed at six months. The described case report highlights the importance of enquiring about non prescribed medication when taking a drug history. Similarly community pharmacists and GPs should be vigilant to excessive requests for DPH, particularly in patients with a psychotic illness.
许多在药店可购得的非处方药都已知具有滥用潜力,包括苯海拉明(DPH),一种具有抗毒蕈碱特性的抗组胺药,用于治疗失眠。我们简要回顾了描述DPH滥用的文献,并报告了GF的病例,GF是一名56岁女性,因从DPH中戒毒而入住住院成瘾治疗单元。文献检索发现了5例DPH滥用的病例报告,共涉及6名患者,发表于1986年至2001年之间。所有报告的病例都表现出符合《精神疾病诊断与统计手册》第四版(DSM-IV)物质依赖标准的特征,并且与抗精神病药物的使用有明显关联。GF接受了抗精神病药物治疗,每天使用多达30片50毫克的DPH片剂。她描述感觉“良好且平静”,并且“震颤停止了”。GF耐受了逐渐减量的计划,并相对舒适地完成了戒毒计划。她按计划从住院戒毒单元出院,并且在6个月时没有复发。所描述的病例报告强调了在获取用药史时询问非处方药物的重要性。同样,社区药剂师和全科医生应该警惕对DPH的过度需求,尤其是在患有精神疾病的患者中。