Sarwar Aliya Iftikhar
Baylor College of Medicine; Parkinson's Disease Research, Education and Clinical Center (PADRECC); and Michael E. DeBakey VA Medical Center, Houston, TX.
Clin Neuropharmacol. 2018 May/Jun;41(3):106-108. doi: 10.1097/WNF.0000000000000278.
Trazodone, the most sedating atypical antidepressant, is widely used as an off-label hypnotic especially in the elderly. Although generally considered safe, it can potentially inhibit midbrain dopaminergic neurotransmission leading to the emergence of extrapyramidal adverse effects. Two previous cases of trazodone-induced parkinsonism have been described after its prolonged use as an antidepressant; however, there is no published case of secondary parkinsonism caused by trazodone in a nondepressed person after its use as a hypnotic. Here, we present a case of rapid development of bradykinetic-rigid parkinsonism temporally linked to the use of trazodone as a hypnotic in a nondepressed elderly man. Because of lack of awareness, this potential association was missed by his primary care physician and general neurologist. He was diagnosed as having idiopathic parkinsonism (Parkinson disease) and referred to a movement disorder neurologist. A secondary cause was suspected by his movement disorder neurologist that led to rapid withdrawal of trazodone and complete reversal of his symptoms. A practice point that needs to be underscored is that trazodone's use as a hypnotic can cause parkinsonism. All health care providers should be aware of this serious but seemingly fully reversible potential adverse effect.
曲唑酮是最具镇静作用的非典型抗抑郁药，被广泛用作非适应证催眠药，尤其在老年人中。尽管一般认为其安全，但它可能抑制中脑多巴胺能神经传递，导致锥体外系不良反应的出现。此前已有两例在长期使用曲唑酮作为抗抑郁药后发生曲唑酮诱发帕金森症的病例报告；然而，尚无关于在非抑郁患者将曲唑酮用作催眠药后导致继发性帕金森症的病例发表。在此，我们报告一例在一名非抑郁老年男性中，与使用曲唑酮作为催眠药在时间上相关的运动迟缓-强直型帕金森症快速进展的病例。由于认识不足，其初级保健医生和普通神经科医生均未发现这种潜在关联。他被诊断为特发性帕金森症（帕金森病）并转诊至运动障碍神经科医生处。其运动障碍神经科医生怀疑存在继发原因，这促使迅速停用曲唑酮，其症状完全逆转。需要强调的一个实践要点是，曲唑酮用作催眠药可导致帕金森症。所有医疗保健提供者均应意识到这种严重但似乎完全可逆的潜在不良反应。
