Division of Toxicology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, Thailand
Department of Psychiatry and Center of Excellence in Transgender Health, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, Thailand.
BMJ Case Rep. 2023 Jun 6;16(6):e254909. doi: 10.1136/bcr-2023-254909.
Depersonalisation/derealisation (DD) syndrome is often associated with severe traumatic experiences and the use of certain medications. Our patient reported experiencing a transient DD phenomenon a few hours after taking 37.5 mg of tramadol, together with etoricoxib, acetaminophen and eperisone. His symptoms subsided upon tramadol discontinuation, suggesting the possibility of tramadol-induced DD. A study of the patient's cytochrome P450 (CYP) 2D6 polymorphism, which mainly metabolises tramadol, indicated normal metaboliser status with reduced function. The concomitant administration of the CYP2D6 inhibitor, etoricoxib, would have led to higher concentrations of the serotonergic parent tramadol, providing an explanation for the patient's symptoms.
人格解体/现实解体（DD）综合征常与严重的创伤经历和某些药物的使用有关。我们的患者报告称，在服用 37.5 毫克曲马多、依托考昔、对乙酰氨基酚和乙哌立松几小时后，出现一过性 DD 现象。停用曲马多后，他的症状缓解，提示曲马多引起 DD 的可能性。对患者细胞色素 P450（CYP）2D6 多态性的研究表明，其主要代谢物曲马多的代谢正常，但功能降低。同时使用 CYP2D6 抑制剂依托考昔会导致血清素前体曲马多的浓度升高，这可以解释患者的症状。
