College of Pharmacy, Southwestern Oklahoma State University, Weatherford, OK, USA.
Ann Pharmacother. 2009 Dec;43(12):2113-6. doi: 10.1345/aph.1M369. Epub 2009 Nov 24.
To describe a case of myxedema coma (MC) associated with combination aripiprazole and sertraline therapy.
A 41-year-old male presented to the emergency department with confusion, right-sided numbness and tingling, slurred speech, dizziness, and facial edema. His blood pressure was 160/113 mm Hg, with a pulse of 56 beats/min and temperature of 35.4 degrees C. Initial abnormal laboratory values included creatine kinase (CK) 439 U/L; serum creatinine 1.6 mg/dL; aspartate aminotransferase 85 U/L; and alanine aminotransferase 35 U/L. Repeat cardiac markers revealed an elevated CK level of 3573 U/L with a CK-MB of 24 ng/mL. Thyroid function tests showed thyroid-stimulating hormone 126.4 microIU/mL and free thyroxine 0.29 ng/dL. Home medications of unknown duration were sertraline 200 mg and aripiprazole 20 mg daily. He was admitted to the intensive care unit and initially treated with intravenous levothyroxine and dexamethasone. By hospital day 4, the patient was clinically stable and discharged to home.
Myxedema coma, the most significant form of hypothyroidism (HT), is a rare but potentially fatal condition. The known precipitating causes of MC were ruled out in this patient, which left his home medications as the likely cause. Cases of HT caused by certain atypical antipsychotics and antidepressants are found in the literature, but none was reported with aripiprazole therapy. There are also no reported cases of sertraline or aripiprazole inducing MC. Use of the Naranjo probability scale indicates that the combination of aripiprazole and sertraline was a probable inducer of MC in this patient.
Due to the widespread use of psychotropic medications, clinicians should be reminded of the rare, yet life-threatening, occurrence of MC when treating patients, especially with combination therapies such as sertraline and aripiprazole.
描述一例与阿立哌唑和舍曲林联合治疗相关的黏液性水肿性昏迷（MC）病例。
一名 41 岁男性因意识混乱、右侧麻木和刺痛、言语不清、头晕和面部水肿而到急诊科就诊。他的血压为 160/113mmHg，脉搏为 56 次/分，体温为 35.4°C。初始异常实验室值包括肌酸激酶（CK）439U/L；血清肌酐 1.6mg/dL；天门冬氨酸氨基转移酶 85U/L；丙氨酸氨基转移酶 35U/L。重复心脏标志物显示 CK 水平升高至 3573U/L，CK-MB 为 24ng/mL。甲状腺功能检查显示促甲状腺激素 126.4μIU/mL，游离甲状腺素 0.29ng/dL。服用的家庭药物为未知时间的舍曲林 200mg 和阿立哌唑 20mg 每日一次。他被收入重症监护病房，最初接受静脉注射左甲状腺素和地塞米松治疗。入院第 4 天，患者临床状况稳定并出院回家。
黏液水肿性昏迷，是最严重的甲状腺功能减退症（HT）形式，是一种罕见但潜在致命的疾病。该患者已排除已知的 MC 诱发因素，这使得他的家庭药物成为可能的原因。文献中有因某些非典型抗精神病药和抗抑郁药导致 HT 的病例报道，但未报告与阿立哌唑治疗相关的病例。也没有舍曲林或阿立哌唑引起 MC 的报告病例。使用 Naranjo 概率量表表明，阿立哌唑和舍曲林的联合使用可能是导致该患者发生 MC 的原因。
由于精神类药物的广泛使用，临床医生在治疗患者时应注意到 MC 这种罕见但危及生命的情况，特别是在使用舍曲林和阿立哌唑等联合治疗时。
