Thompson D F, Pierce D R
Department of Pharmacy Practice, School of Pharmacy, Southwestern Oklahoma State University, Oklahoma City 73102, USA.
Ann Pharmacother. 1999 Jan;33(1):93-8. doi: 10.1345/aph.18150.
To compile and assess the English-language literature on drug-induced nightmares, excluding nightmares secondary to drug withdrawal or drug-associated night terrors.
Published articles, letters, case reports, and abstracts in English were identified by MEDLINE (1966-May 1998) searches using the search term nightmares, chemically induced. Additional articles were obtained from bibliographies of retrieved articles.
All case reports of drug-induced nightmares were evaluated using the Naranjo algorithm for causality. Clinical studies of drugs that reported nightmares as an adverse effect were assessed for frequency of occurrence.
Nightmares, defined as nocturnal episodes of intense anxiety and fear associated with a vivid, emotionally charged dream experience, are generally classified as a parasomnia. Possible pharmacologic mechanisms for drug-induced nightmares, such as REM suppression and dopamine receptor stimulation, are reviewed. However, the vast majority of therapeutic agents implicated in causing nightmares have no obvious pharmacologic mechanism.
Assessing causality with an event such as a nightmare is difficult because of the high incidence of nightmares in the healthy population. Using qualitative, quantitative, and possible pharmacologic mechanism criteria, it appears that sedative/hypnotics, beta-blockers, and amphetamines are the therapeutic modalities most frequently associated with nightmares. These drug classes have a plausible pharmacologic mechanism to explain this effect. Dopamine agonists also have evidence of causality, with dopamine receptor stimulation as a possible pharmacologic mechanism.
汇编并评估关于药物诱发噩梦的英文文献，排除因药物戒断或与药物相关的夜惊继发的噩梦。
通过MEDLINE（1966年至1998年5月）检索，使用搜索词“化学诱导的噩梦”识别英文发表的文章、信件、病例报告和摘要。其他文章从检索到的文章的参考文献中获取。
使用Naranjo因果关系算法评估所有药物诱发噩梦的病例报告。对报告噩梦为不良反应的药物的临床研究评估其发生频率。
噩梦定义为与生动、充满情感的梦境体验相关的夜间强烈焦虑和恐惧发作，通常归类为异态睡眠。回顾了药物诱发噩梦的可能药理机制，如快速眼动睡眠抑制和多巴胺受体刺激。然而，绝大多数与诱发噩梦有关的治疗药物没有明显的药理机制。
由于健康人群中噩梦的高发生率，评估噩梦等事件的因果关系很困难。使用定性、定量和可能的药理机制标准，似乎镇静催眠药、β受体阻滞剂和苯丙胺是最常与噩梦相关的治疗方式。这些药物类别有合理的药理机制来解释这种效应。多巴胺激动剂也有因果关系的证据，多巴胺受体刺激是一种可能的药理机制。
