Spencer M J
Pediatrics. 1993 Nov;92(5):721-2.
A case of fluoxetine toxicity in a newborn of 38 weeks' gestation has been presented. The total drug concentration in cord blood was 80 ng/mL. The fluoxetine level, 26 ng/mL, is below the adult therapeutic level; the norfluoxetine cord blood level, 54 ng/mL, is at the adult therapeutic level. At 96 hours the fluoxetine level was not measurable and the norfluoxetine level was 55 ng/mL. The parent compound is fluoxetine, which is metabolized in the liver to norfluoxetine. The half-life of fluoxetine is 2 to 3 days, and that of norfluoxetine is 7 to 9 days. Interestingly, in our patient the fluoxetine was absent in the blood at 4 days, but norfluoxetine was present. The most common side effects of Prozac in adult patients involve primarily the central nervous system and include nervousness, tremor, jitteriness, and occasionally seizures. Central nervous system symptoms were most prominent in this newborn. He also had an increased heart rate. Cardiovascular side effects are less prominent in adults who are taking Prozac. The neonate in this case was asymptomatic at 96 hours of age, indicating that the parent compound, fluoxetine, may be the active part of the drug and side effects may be caused by the parent compound.
本文报告了一例孕38周新生儿氟西汀中毒的病例。脐血中药物总浓度为80 ng/mL。氟西汀水平为26 ng/mL，低于成人治疗水平；去甲氟西汀脐血水平为54 ng/mL，处于成人治疗水平。96小时时，氟西汀水平无法测得，去甲氟西汀水平为55 ng/mL。母体化合物是氟西汀，它在肝脏中代谢为去甲氟西汀。氟西汀的半衰期为2至3天，去甲氟西汀的半衰期为7至9天。有趣的是，在我们的患者中，4天时血液中没有氟西汀，但有去甲氟西汀。成人患者使用百忧解最常见的副作用主要涉及中枢神经系统，包括紧张、震颤、神经过敏，偶尔还会出现癫痫发作。中枢神经系统症状在该新生儿中最为突出。他的心率也有所增加。服用百忧解的成人中，心血管副作用不太明显。该病例中的新生儿在96小时龄时无症状，这表明母体化合物氟西汀可能是药物的活性部分，副作用可能由母体化合物引起。
