1例87岁女性阿尔茨海默病患者服用多奈哌齐（5 mg、1次/d）8年后，因病情进展加服美金刚（10 mg、1次/d）。3个月后，患者突发昏迷，呼之不应，呼吸急促，喘憋；双眼瞳孔针尖样改变，血压190/100 mmHg（1 mmHg=0。133 kPa），心率56次/min，格拉斯哥昏迷评分（GCS）为E1V1M1。考虑患者为多奈哌齐和美金刚联用导致药物蓄积中毒（美金刚血浓度215 mg/L，警戒值：30 mg/L；多奈哌齐血浓度33 mg/L，警戒值：20 mg/L）。停用2药，给予补液水化、降压、醒脑等对症支持治疗。停药第3天，患者意识一过性转为嗜睡，GCS评分为E2V2M2；停药第7天，患者意识转清，可简单对答，GCS评分为E4V4M4，血压126/67 mmHg，瞳孔大小恢复正常。 An 87-year-old female patient with Alzheimer's disease received donepezil 5 mg once daily orally for 8 years and then memantine 10 mg once daily orally was added due to the progression of the condition。 Three months later， the patient suddenly fell into a coma and did not respond to call， acompanied by shortness of breath and wheezing。 The patient had needle like changes in the pupils of both eyes， with blood pressure 190/100 mmHg and heart rate 56 beats per minute。 The Glasgow Coma Scale (GCS) was E1V1M1。 It was considered that the patient was poisoned due to drug accumulation caused by combination use of donepezil and memantine (blood concentration of methotrexate 215 mg/L， warning value: 30 mg/L blood concentration of donepezil 33 mg/L， warning value: 20 mg/L)。 The 2 drugs were stopped， and symptomatic and supportive treatments such as fluid hydration， blood pressure reduction， and brain awakening were given。 On the 3th day after drug discontinuation， the patient′s consciousness temporarily shifted to drowsiness， and her GCS was E1V1M1 on the 7th day after drug discontinuation， the patient′s consciousness became clear and she was able to answer simple questions， with GCS E4V4M4， blood pressure 126/67 mmHg， and normal pupil size。
Drug accumulation and coma caused by the combination of donepezil and memantine
An 87-year-old female patient with Alzheimer's disease received donepezil 5 mg once daily orally for 8 years and then memantine 10 mg once daily orally was added due to the progression of the condition. Three months later, the patient suddenly fell into a coma and did not respond to call, acompanied by shortness of breath and wheezing. The patient had needle like changes in the pupils of both eyes, with blood pressure 190/100 mmHg and heart rate 56 beats per minute. The Glasgow Coma Scale (GCS) was E1V1M1. It was considered that the patient was poisoned due to drug accumulation caused by combination use of donepezil and memantine (blood concentration of methotrexate 215 mg/L, warning value: 30 mg/L blood concentration of donepezil 33 mg/L, warning value: 20 mg/L). The 2 drugs were stopped, and symptomatic and supportive treatments such as fluid hydration, blood pressure reduction, and brain awakening were given. On the 3th day after drug discontinuation, the patient′s consciousness temporarily shifted to drowsiness, and her GCS was E1V1M1 on the 7th day after drug discontinuation, the patient′s consciousness became clear and she was able to answer simple questions, with GCS E4V4M4, blood pressure 126/67 mmHg, and normal pupil size.
万方数据
