Cohen Johan Y, Guilbault Amélie
Cohen, MD, Guilbault, Psychiatry department, University of Montreal, Canada.
Psychopharmacol Bull. 2018 Jun 20;48(4):15-19.
Due to the stringent regulatory environment for therapeutics, common side-effects of drugs in the general population are largely well-documented. This is however less the case with certain patient subgroups who may exhibit significant adverse responses to therapeutics that are otherwise well-tolerated. We report a case of psychosis induced by exposure to a commonly prescribed drug to treat muscle spasms and associated pain cyclobenzaprine (Flexeril®). Cyclobenzaprine is structurally very similar to tricyclic anti-depressants, such as amyltriptine. While it is well known that agitation caused by cyclobenzaprine is not an uncommon occurrence in the elderly, there have also been sporadic reports of significant psychosis in association with the use of cyclobenzaprine in younger patients. We report a case of reversible mania in a susceptible 44-year-old patient with a lengthy history of mild borderline personality and bipolar disorder. Shortly after being treated with cyclobenzaprine for pain due to a minor injury, this patient exhibited significant signs of mania although these signs were readily reversible upon termination of the treatment with cyclobenzaprine. The patient's severe adverse reaction to this normally innocuous drug adds weight to the notion that there is reason for caution with its prescription for potentially susceptible patient subgroups.
由于治疗药物的监管环境严格，一般人群中药物的常见副作用大多有充分记录。然而，某些患者亚组的情况并非如此，他们可能对其他情况下耐受性良好的治疗药物表现出显著的不良反应。我们报告一例因接触常用的治疗肌肉痉挛及相关疼痛的药物环苯扎林（Flexeril®）而诱发精神病的病例。环苯扎林在结构上与三环类抗抑郁药（如阿米替林）非常相似。虽然众所周知，环苯扎林引起的激动在老年人中并不罕见，但也有零星报道称，年轻患者使用环苯扎林会出现严重精神病。我们报告一例44岁易感性患者出现可逆性躁狂的病例，该患者有长期轻度边缘型人格和双相情感障碍病史。在用环苯扎林治疗因轻伤引起的疼痛后不久，该患者出现了明显的躁狂症状，尽管在停用环苯扎林治疗后这些症状很容易逆转。该患者对这种通常无害的药物出现严重不良反应，这进一步证明了对于潜在易感患者亚组开具该药物处方时应谨慎的观点。
