Jackson C W, Markowitz J S, Brewerton T D
Institute of Psychiatry, Medical University of South Carolina, Charleston, USA.
Ann Clin Psychiatry. 1995 Sep;7(3):139-41. doi: 10.3109/10401239509149041.
Delirium has many organic causes, one of which is the combination of medications. This is sometimes difficult to differentiate in the psychotic individual. To our knowledge there are no published cases of delirium definitively established by "rechallenge" with a combination of clozapine and benzodiazepines. Lorazepam was given for agitation in two individuals on clozapine. Because of either the short half-life, or the lack of knowledge about this interaction, multiple doses were given. Clonazepam was given to a third individual. Two of the reported individuals developed a delirium associated with the administration and onset of lorazepam. These patients had received both lorazepam and clozapine singularly in the past without the adverse effects seen with the combination. Both patients were rechallenged with second doses of lorazepam, when they again developed a delirium. In one case the patient was admitted on clonazepam and then started on clozapine. A delirium developed at a clozapine dose of 150 mg/day; she was not rechallenged. In all three cases the patients' sensorium cleared when benzodiazepines were discontinued. The combination of benzodiazepines and clozapine should be avoided if possible, and if they are used in combination, it should be with great caution.
谵妄有多种器质性病因，其中之一是药物联用。这在患有精神病的个体中有时难以鉴别。据我们所知，尚无因氯氮平与苯二氮䓬类药物联用“再激发试验”明确确诊谵妄的病例报告。有两名服用氯氮平的患者因烦躁不安而使用了劳拉西泮。由于其半衰期短，或者对这种相互作用缺乏了解，所以给予了多次剂量。第三名患者使用了氯硝西泮。报告的两名患者出现了与劳拉西泮给药及起效相关的谵妄。这两名患者过去单独使用过劳拉西泮和氯氮平，均未出现联用后的不良反应。两名患者再次使用第二剂劳拉西泮时，又出现了谵妄。其中一例患者入院时服用氯硝西泮，之后开始使用氯氮平。氯氮平剂量为150毫克/天时出现了谵妄；未对她进行再激发试验。在所有三例病例中，停用苯二氮䓬类药物后患者的神志清醒。应尽可能避免苯二氮䓬类药物与氯氮平联用，若联用，则应极其谨慎。
