Pourmand A, Shay C, Redha W, Aalam A, Mazer-Amirshahi M
Department of Emergency Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, United States.
Department of Emergency Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, United States.
Am J Emerg Med. 2017 Sep;35(9):1386.e1-1386.e3. doi: 10.1016/j.ajem.2017.06.044. Epub 2017 Jun 22.
Donepezil is the most commonly prescribed acetylcholinesterase inhibitor for the treatment of Alzheimer's disease, an ailment that affects millions of older adult patients. By inhibiting the breakdown of acetylcholine in the central nervous system, donepezil has been shown to slow cognitive decline and improve patients' functional status. While donepezil is well-tolerated and generally considered safe at therapeutic doses, taking more than the prescribed dose could result in adverse cholinergic effects that range from mild gastrointestinal distress to serious cardiac dysrhythmias. We present a case of an 84-year-old man who developed gastrointestinal and cardiac disturbances after ingesting seven-times his daily dose of donepezil. As no specific antidote is available for donepezil overdose, this case highlights the importance of supportive care with particular attention to the management of cardiac dysrhythmias in patients displaying signs of toxicity.
多奈哌齐是治疗阿尔茨海默病最常用的处方乙酰胆碱酯酶抑制剂，这种疾病影响着数百万老年患者。通过抑制中枢神经系统中乙酰胆碱的分解，多奈哌齐已被证明可以减缓认知衰退并改善患者的功能状态。虽然多奈哌齐耐受性良好，治疗剂量下通常被认为是安全的，但服用超过规定剂量可能会导致不良胆碱能效应，从轻度胃肠道不适到严重的心律失常。我们报告一例84岁男性病例，该患者在摄入其每日剂量7倍的多奈哌齐后出现胃肠道和心脏紊乱。由于没有针对多奈哌齐过量的特效解毒剂，该病例凸显了支持性治疗的重要性，尤其要注意对出现中毒迹象患者的心律失常管理。
