Dose and serum concentration relationships in cimetidine-associated mental confusion.
Dose and serum concentration relationships in cimetidine-associated mental confusion.
复制标题
西咪替丁相关精神混乱的剂量和血清浓度关系。
DOI：
10.1016/0016-5085(80)90685-x
复制
发表时间：
1980
期刊：
影响因子：
29.4
通讯作者：
Jerome J. Schentag
中科院分区：
文献类型：
--
作者：
B. Kimelblatt;F. Cerra;G. Calleri;M. J. Berg;M. McMillen;Jerome J. Schentag
一名患有严重肝病且肾功能轻度异常但稳定的患者，曾两次因胃肠道出血而服用西咪替丁。在每个疗程中，剂量都是推荐剂量的一半，每天600毫克，开始剂量后不久，精神状态就会恶化。如果剂量进一步减少到每天300毫克，就可以在没有精神状态改变的情况下继续接受西咪替丁治疗。在这位患者中，精神状态的改变发生在比我们之前报道的更低的血清浓度。这一差异可以通过对西咪替丁脑脊液浓度的分析来解释，因为该患者的西咪替丁血液对脑脊液的通透性异常高。虽然脑脊液浓度升高的原因尚不清楚，但西咪替丁相关的精神障碍是剂量相关的，并且在剂量减少后完全可逆。出现西咪替丁相关精神状态改变的患者和无法停止治疗的患者，可以通过个体化给药率进行安全治疗。
A patient with severe liver disease and mildly abnormal but stable renal function was given cimetidine on two occasions for gastrointestinal hemorrhage. In each course, dosing was initiated at half the recommended dosage of 600 mg daily, and mental status deteriorated shortly after dosing began. A further dosage decrease to 300 mg daily allowed continuation of cimetidine therapy in absence of mental status alterations. In this patient, mental status changes occurred at lower serum concentrations than we have previously reported. This discrepancy was explained by analysis of cimetidine CSF concentrations, as this patient had abnormally high cimetidine blood to CSF permeability. Although the cause of increased CSF concentrations is unclear, cimetidine-associated mental confusion was dose related and completely reversible upon a decrease in dosage. Patients who develop cimetidine-associated mental status changes and who cannot have treatment stopped may be safely treated by individualizing the dosing rate.