Russell W L, Lopez L M
Am J Hosp Pharm. 1980 Dec;37(12):1667-71.
An apparent case of psychosis induced by cimetidine is reported. A 61-year-old Caucasian woman was hospitalized with chief complaints of left-sided paresthesias, headache, and vertigo. She had a history of hyperparathyroidism, thyroid insufficiency, and chronic but stable renal insufficiency. Admitting laboratory data indicated possible hepatic compromise. On day 16 of hospitalization, cimetidine (300 mg q 6 hr p.o.) was begun because of a falling hematocrit and guaiac-positive stools. Within 24 hours after cimetidine therapy was begun, the patient was confused, tearful, and disoriented. This confusional state continued during treatment with cimetidine, and was refractory to antipsychotic therapy. On day 5 of cimetidine therapy, the patient experienced visual and auditory hallucinations, and both cimetidine and antipsychotic drugs were discontinued. The patient was noted to be alert and oriented 24 hours later. A review of the literature revealed 30 cases of apparent cimetidine-induced CNS changes. Patients experiencing such reactions were typically elderly with compromised renal or hepatic failure, or both. Future studies on this topic should focus on predisposing patient factors and serum or cerebrospinal fluid concentrations of cimetidine associated with the symptomology.
报告了1例由西咪替丁诱发的明显精神病病例。一名61岁的白人女性因左侧感觉异常、头痛和眩晕为主诉入院。她有甲状旁腺功能亢进、甲状腺功能不全和慢性但稳定的肾功能不全病史。入院时实验室检查数据提示可能存在肝脏损害。住院第16天，由于血细胞比容下降和粪便隐血阳性，开始口服西咪替丁（300mg，每6小时1次）。在开始西咪替丁治疗后24小时内，患者出现意识模糊、流泪和定向障碍。在西咪替丁治疗期间，这种意识模糊状态持续存在，且对抗精神病药物治疗无效。在西咪替丁治疗第5天，患者出现视幻觉和听幻觉，西咪替丁和抗精神病药物均停用。24小时后患者被观察到警觉且定向力正常。文献回顾显示有30例明显的西咪替丁诱发的中枢神经系统改变病例。出现此类反应的患者通常为老年人，伴有肾功能或肝功能衰竭，或两者皆有。关于该主题的未来研究应关注易患患者因素以及与症状相关的西咪替丁血清或脑脊液浓度。
