University of Toronto, Faculty of Medicine (XW); Centre of Addiction and Mental Health, Addictions Division (FDP, NC); University of Toronto, Department of Family & Community Medicine (FDP); University of Toronto, Department of Psychiatry, Ontario, Canada (NC).
J Addict Med. 2019 Sep/Oct;13(5):412-414. doi: 10.1097/ADM.0000000000000511.
: Reporting of intoxication and withdrawal from aberrant use of over-the-counter medication has been sparse and inconsistent in literature. Attributed to their anticholinergic properties, medications such as dimenhydrinate (Gravol) taken in supratherapeutic doses have been associated with euphoria, anxiolysis, and hallucinations. We present a case of a woman in her forties, with a psychiatric history of bipolar disorder, and complex concurrent medical history including familial Mediterranean fever (FMF), and fibromyalgia, admitted for withdrawal management of her intravenous dimenhydrinate use. As a result of her FMF, there were numerous hospital admissions and treatment which required intravenous access. Hence, a physician-inserted intravenous access port was placed on her chest. The port was maintained monthly with the help of a community agency. In this port, she was injecting 100 to 200 mg of dimenhydrinate hourly for its euphoric and calming effects, consuming upwards of 2400 mg/d. Comprehensive laboratory work-up and urine drug screening were unremarkable. Vital signs were stable. Her mental status at time of admission was lethargic, unfocused, but calm. Her withdrawal symptoms included severe nausea, vomiting, sedation, headaches, dizziness, anxiety, and muscle stiffness. Her detoxification was managed with benztropine and lorazepam, and was well tolerated. The patient was discharged to a community inpatient rehabilitation center. Urine drug testing before discharge was negative. This case draws attention to the addictive potential of dimenhydrinate and offers a regime for its medical withdrawal management. Additionally, this case highlights that screening and management of over-the-counter medications warrants further clinical consideration and investigation.
: 关于非处方药物滥用导致中毒和戒断的报告在文献中很少且不一致。由于具有抗胆碱能特性，苯海拉明（Gravol）等药物在治疗剂量以上使用时与欣快感、焦虑缓解和幻觉有关。我们报告了一例四十多岁的女性，有双相情感障碍的精神病史，同时还有复杂的并发医学史，包括家族性地中海热（FMF）和纤维肌痛，因静脉注射苯海拉明戒断而入院。由于她患有 FMF，她多次住院并需要静脉输液。因此，在她的胸部放置了一个医生插入的静脉输液港。在社区机构的帮助下，每月对该输液港进行维护。她在这个输液港中每小时注射 100 至 200 毫克苯海拉明，以获得欣快和镇静的效果，每天的摄入量超过 2400 毫克。全面的实验室检查和尿液药物筛查均无异常。生命体征稳定。入院时她的精神状态为昏睡、注意力不集中但平静。她的戒断症状包括严重的恶心、呕吐、镇静、头痛、头晕、焦虑和肌肉僵硬。她的解毒治疗使用苯海拉明和劳拉西泮，耐受性良好。患者出院到社区住院康复中心。出院前的尿液药物检测呈阴性。该病例引起了对苯海拉明成瘾潜力的关注，并提供了一种用于其医学戒断管理的方案。此外，该病例还强调了对非处方药物的筛查和管理需要进一步的临床考虑和研究。
