Gu Chun-Ping, Xie Yue-Liang, Liao Yin-Juan, Wu Cui-Fang, Wang Sheng-Feng, Zhou Yu-Lu, Jia Su-Jie
Department of Pharmaceutics, The Third Xiangya Hospital, Central South University, Tongzipo Road #138, Changsha, 410013, China.
Department of Pharmaceutics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
Drug Saf Case Rep. 2018 Apr 6;5(1):14. doi: 10.1007/s40800-018-0082-3.
A 66-year-old male patient with a 10-year course of Parkinson's disease (PD) was admitted for hallucination lasting a half a month. After treatment with levodopa/carbidopa, selegiline, and piribedil, the patient's motor symptoms were improved while no significant effects were observed on psychotic symptoms. A clinical pharmacist analyzed the pharmacologic and pharmacokinetic characteristics of selegiline and piribedil, summarized the scheme of PD with psychotic symptoms in the literature, and discovered that selegiline might potentiate psychotic side effects of piribedil, while the use of levodopa/carbidopa cannot be ruled out either. Finally, the clinical pharmacist proposed to reduce the dosage of levodopa/carbidopa, increase the dosage of selegiline and quetiapine, and discontinue piribedil. The clinician accepted this suggestion. After the adjustment of medication, the patient's motor symptoms were absolutely improved and the psychotic symptoms were notably improved. This case study suggests that long-term treatment with levodopa/carbidopa and piribedil, along with the progression of the disease itself, could contribute to the emergence of psychotic symptoms in PD. Additionally, selegiline could potentiate psychotic side effects of piribedil. Neurology clinical pharmacists should work alongside neurology clinicians at the bedside to optimize pharmacotherapy, improve patient safety, and contribute to scholarly efforts.
一名患有10年帕金森病（PD）病程的66岁男性患者因幻觉持续半个月入院。在接受左旋多巴/卡比多巴、司来吉兰和吡贝地尔治疗后，患者的运动症状有所改善，但精神症状未见明显改善。一名临床药师分析了司来吉兰和吡贝地尔的药理及药代动力学特性，总结了文献中帕金森病伴精神症状的治疗方案，发现司来吉兰可能会增强吡贝地尔的精神副作用，同时也不能排除左旋多巴/卡比多巴的作用。最后，临床药师建议减少左旋多巴/卡比多巴的剂量，增加司来吉兰和喹硫平的剂量，并停用吡贝地尔。临床医生接受了这一建议。调整用药后，患者的运动症状完全改善，精神症状明显改善。该病例研究表明，长期使用左旋多巴/卡比多巴和吡贝地尔，以及疾病本身的进展，可能导致帕金森病患者出现精神症状。此外，司来吉兰可能会增强吡贝地尔的精神副作用。神经内科临床药师应在床边与神经内科临床医生合作，优化药物治疗，提高患者安全性，并为学术研究做出贡献。
