Eisendrath S J, Goldman B, Douglas J, Dimatteo L, Van Dyke C
Am J Psychiatry. 1987 Aug;144(8):1062-5. doi: 10.1176/ajp.144.8.1062.
Despite the widespread use of meperidine as an analgesic, its potential for producing delirium has been overlooked. Six cases demonstrating meperidine-induced behavioral toxicity are reported. Toxicity was more likely when meperidine was combined with cimetidine or drugs having anticholinergic activity. Discontinuation of meperidine and substitution of morphine for analgesia were usually successful in treating the delirium. Physostigmine reversed the delirium in one patient. The authors suggest that the delirium results from the excessive anticholinergic activity of meperidine or its only active metabolite, normeperidine.
尽管哌替啶作为一种镇痛药被广泛使用，但其产生谵妄的可能性却被忽视了。本文报告了6例哌替啶诱发行为毒性的病例。当哌替啶与西咪替丁或具有抗胆碱能活性的药物合用时，更易出现毒性反应。停用哌替啶并改用吗啡镇痛通常能成功治疗谵妄。毒扁豆碱使1例患者的谵妄得到逆转。作者认为，谵妄是由哌替啶或其唯一的活性代谢产物去甲哌替啶的抗胆碱能活性过高所致。
