In Reply: Spontaneous MAOI hypertensive reaction, not likely armodafinil - tranylcypromine interaction.
In Reply: Spontaneous MAOI hypertensive reaction, not likely armodafinil - tranylcypromine interaction.
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答复：自发性 MAOI 高血压反应，不太可能是阿莫达非尼 - 反苯环丙明相互作用。
DOI：
10.1016/j.jns.2019.01.002
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发表时间：
2019
影响因子：
4.4
通讯作者：
Miller,ElizaC
中科院分区：
文献类型：
--
作者：
Kinslow,ConnorJ;Miller,ElizaC
我们要感谢Feinberg博士对我们病例报告的评论，在该报告中，我们描述了一名患者在调整阿莫达非尼和反苯环丙胺给药方案后数小时发生急性高血压危象。我们同意，她的反应可能是自发性高血压危象，仅由MAOI引起，而不是两种药物联合引起。重度高血压发作在接受MAOI治疗的患者中很少见（低于1%），无饮食不依从或使用限制性药物史的患者中无诱因或自发性发作将是罕见的[1]。莫达非尼及其第二代对映体阿莫达非尼的作用机制尚不明确，因为这些化合物对脑内的儿茶酚胺、5-羟色胺、谷氨酸、γ-氨基丁酸、食欲素和组胺系统表现出稳健的作用[2]。这些系统通过其神经递质的细胞外浓度的变化和其各自受体的直接激动/拮抗来调节。阿莫达非尼比莫达非尼更有效，并且具有显著不同的药代动力学特征[3]，因此难以预测其与其他药物联合使用的安全性特征。出于这个原因，一些来源警告或禁忌将其与MAOI联合使用，以降低急性高血压发作的风险[4]。我们欢迎更多关于这两种药物一起使用的病例报告，例如Feinberg博士在他的评论中所描述的病例。我们认为，我们目前的数据仍然支持我们的结论，即医生在同时使用这两种药物时应谨慎。专家仍然可以选择使用组合，但建议对这种方案的患者进行仔细监测[4]。
We would like to thank Dr. Feinberg for his comments on our case report, in which we describe a patient who developed an acute hypertensive crisis, hours after her dosing schedule of armodafinil and tranylcypromine was adjusted. We agree that it is possible that her reaction was a spontaneous hypertensive crisis due solely to the MAOI, and not a combination of the two drugs. Severe hypertensive episodes are rare in patients receiving MAOIs (less than 1%), and an unprovoked or spontaneous episode in a patient without a history of dietary noncompliance or use of restricted medications would be unusual [1]. There is ambiguity regarding the mechanism of action of modafinil and its secondgeneration enantiomer, armodafinil, as the compounds exhibit robust effects on catecholamine, serotonin, glutamate, gamma amino-butyric acid, orexin, and histamine systems within the brain [2]. These systems are modulated both by changes in the extracellular concentrations of their neurotransmitters and by direct agonism/antagonism of their respective receptors. Armodafinil is more potent than modafinil and has a substantially different pharmacokinetic profile [3], making it difficult to predict its safety profile in combination with other drugs. For this reason, their use in combination with MAOIs is either cautioned or contraindicated by some sources for risk of acute hypertensive episodes [4]. We would welcome more reports of cases in which the two drugs are used together, such as those described by Dr. Feinberg in his commentary. We believe that the data we present still support our conclusion, that physicians should exercise caution if using these two drugs together. Experts may still choose to use the combination, but it has been recommended that patients on this regimen be carefully monitored [4].