Sonnenblick M, Rosin A J, Weissberg N
Postgrad Med J. 1982 Jul;58(681):415-8. doi: 10.1136/pgmj.58.681.415.
Neurological and psychiatric side effects of cimetidine are reviewed in 47 cases from the literature, and 3 further cases are described. Confusion, psychomotor restlessness, hallucinations and disorientation, stupor and coma were the main features; some had convulsions and a few exhibited focal neurological deficits or neuropathies. The signs appeared within 2 days in almost half of the patients, and remitted in most within 2-3 days. Predisposing factors, of which more than one may be present, are advanced age, hepatic or renal dysfunction, or severe underlying disease. The 3 cases described were all old, one had cirrhosis with bleeding oesophageal varices, and one had renal failure with nephrotic syndrome and amyloidosis. In view of the increasingly wide use of cimetidine, conditions in which there is decreased metabolic breakdown, or excretion, or predisposition to increased brain levels should prompt careful follow-up, and possibly a lower dosage regimen, especially in elderly patients.
对文献中47例西咪替丁的神经和精神副作用进行了综述，并描述了另外3例病例。主要症状包括意识模糊、精神运动性不安、幻觉和定向障碍、木僵和昏迷；部分患者出现惊厥，少数患者表现为局灶性神经功能缺损或神经病变。几乎一半的患者在2天内出现症状，大多数患者在2 - 3天内症状缓解。诱发因素可能不止一种，包括高龄、肝肾功能不全或严重的基础疾病。所描述的3例病例均为老年患者，1例患有肝硬化伴食管静脉曲张出血，1例患有肾衰竭伴肾病综合征和淀粉样变性。鉴于西咪替丁的使用越来越广泛，对于代谢分解或排泄减少、或易于脑内水平升高的情况，应进行仔细随访，并可能采用较低的剂量方案，尤其是在老年患者中。
