Graber M A, Hoehns T B, Perry P J
Department of Family Practice, College of Medicine, University of Iowa, Iowa City 52242.
Ann Pharmacother. 1994 Jun;28(6):732-5. doi: 10.1177/106002809402800610.
To report a serious drug interaction possibly occurring with the monoamine oxidase inhibitor phenelzine and the selective serotonin reuptake inhibitor sertraline.
A 61-year-old woman with treatment-refractory major depressive disorder was being treated unsuccessfully with lithium, phenelzine, thioridazine, and doxepin. Sertaline 100 mg/d was added to the patient's therapy. Within three hours of ingesting the first dose, the patient experienced a dramatic increase in her temperature, pulse, and respirations along with labile blood pressure, and symptoms of rigidity, diaphoresis, shivering, and decreased sensorium. The patient was transported to the emergency room and treated with diazepam 10 mg iv, followed by midazolam 10 mg iv for control of rigidity. She was also intubated. The patient then experienced precipitous falls in her blood pressure and respiratory rate. Ice packs combined with a cooling blanket and dantrolene 80 mg iv were administered to control fever and rigidity, respectively. She had an initial working diagnosis of neuroleptic malignant syndrome, which was later changed to serotonin syndrome. Dantrolene was continued for 72 hours at which time the patient was extubated and transferred to a psychiatric unit.
Selective serotonin reuptake inhibitor antidepressants should not be combined with monoamine oxidase inhibitor antidepressants because of the risk of serotonin syndrome.
报告一种可能发生在单胺氧化酶抑制剂苯乙肼与选择性5-羟色胺再摄取抑制剂舍曲林之间的严重药物相互作用。
一名61岁患有难治性重度抑郁症的女性，使用锂盐、苯乙肼、硫利达嗪和多塞平治疗均未成功。在其治疗方案中加用了舍曲林100mg/d。在服用首剂药物的三小时内，患者体温、脉搏和呼吸急剧上升，同时伴有血压波动不稳，出现了强直、多汗、寒战及意识水平下降等症状。患者被送往急诊室，先静脉注射10mg地西泮，随后静脉注射10mg咪达唑仑以控制强直。患者还进行了气管插管。随后患者血压和呼吸频率急剧下降。分别使用冰袋、降温毯及静脉注射80mg丹曲林来控制发热和强直。患者最初的初步诊断为抗精神病药恶性综合征，后来改为血清素综合征。丹曲林持续使用72小时，之后患者拔管并转至精神科病房。
由于存在血清素综合征的风险，选择性5-羟色胺再摄取抑制剂类抗抑郁药不应与单胺氧化酶抑制剂类抗抑郁药联合使用。
