Zhou Bojie, Yang Shanghao, Zhou Xiafeng, Chen Qian, Tu Ewen, Zhang Bo, Shi Li, Zhou Xuhui
The School of Clinical Medicine, Hunan University of Chinese Medicine, Changsha, China.
Department of Addiction Medicine, Hunan Institute of Mental Health, The Second People's Hospital of Hunan Province (Brain Hospital of Hunan Province), Changsha, China.
Front Psychiatry. 2025 Apr 3;16:1537822. doi: 10.3389/fpsyt.2025.1537822. eCollection 2025.
Polydrug use has caused serious harm to public health, especially involving novel psychoactive substances. Tiletamine, an N-methyl-D-aspartate receptor (NMDAR) antagonist commonly used as a veterinary anesthetic, has recently emerged in China as an additive in e-cigarettes. However, the long-term impacts of tiletamine and its combined use with other substances remain poorly understood. This case report aims to provide further insight into the clinical manifestations and treatment of tiletamine abuse, particularly focusing on the tremors induced by polydrug use.
The patient had five years of intermittent alcohol use and five months of etomidate abuse. After combining tiletamine for two months, he was repeatedly hospitalized due to coarse tremors, poor sleep and appetite. Based on his substance use pattern and related outcomes, he was diagnosed with phencyclidine use disorder. Initially, intravenous diazepam (20 mg/day) effectively alleviated the tremors. During the second hospitalization, the same dose took longer to take effect, and by the third hospitalization, the dose was increased to 30 mg/day without reducing the tremors. Therefore, primidone was added and gradually titrated to 50 mg/day. The patient's tremors began to improve by the eighth day and significantly diminished by the tenth day. As we gradually replaced diazepam with lorazepam, the patient insisted on discharge.
Polydrug users, particularly those using NMDAR antagonists and gamma-aminobutyric acid type A receptor (GABA-AR) agonists, may be at increased risk of developing tiletamine dependence, with more severe consequences due to cross-addiction. The combination of alcohol and tiletamine could exacerbate neuroexcitotoxicity during withdrawal, potentially contributing to severe tremors. The successful management of tremors with a combination of neuroinhibitory therapies suggested an effective strategy for complex cases. Further studies are needed to better understand the long-term impacts and risks of tiletamine dependence.
多药滥用对公众健康造成了严重危害，尤其是涉及新型精神活性物质。替来他明是一种常用作兽用麻醉剂的N-甲基-D-天冬氨酸受体（NMDAR）拮抗剂，最近在中国作为电子烟添加剂出现。然而，替来他明及其与其他物质联合使用的长期影响仍知之甚少。本病例报告旨在进一步深入了解替来他明滥用的临床表现和治疗方法，尤其关注多药联合使用引起的震颤。
该患者有五年间歇性饮酒史和五个月依托咪酯滥用史。在联合使用替来他明两个月后，他因粗大震颤、睡眠和食欲不佳而多次住院。根据他的物质使用模式和相关结果，他被诊断为苯环利定使用障碍。最初，静脉注射地西泮（20毫克/天）有效缓解了震颤。在第二次住院期间，相同剂量起效时间变长，到第三次住院时，剂量增加到30毫克/天仍未减轻震颤。因此，加用扑米酮并逐渐滴定至50毫克/天。患者的震颤在第八天开始改善，第十天明显减轻。当我们逐渐用地西泮替换为劳拉西泮时，患者坚持出院。
多药使用者，尤其是那些使用NMDAR拮抗剂和γ-氨基丁酸A型受体（GABA-AR）激动剂的人，可能有更高的风险产生替来他明依赖性，由于交叉成瘾会导致更严重的后果。酒精和替来他明的联合使用可能会在戒断期间加剧神经兴奋毒性作用，并可能导致严重震颤。联合使用神经抑制疗法成功控制震颤提示了一种针对复杂病例的有效策略。需要进一步研究以更好地了解替来他明依赖性的长期影响和风险。
