精神分裂症患者氯氮平中毒1例  

A case report of a schizophrenia patient with clozapine intoxication

作　　者：林允安 及晓 Lin Yunan;Ji Xiao(Beijing Anding Hospital Capital Medical University,Beijing 100088,China)

机构地区：[1]首都医科大学附属北京安定医院,北京100088

出　　处：《中华精神科杂志》2024年第9期620-622,共3页Chinese Journal of Psychiatry

基　　金：2022年度国家临床重点专科建设项目(2021-PT40)。

摘　　要：本文报道1例长期服用氯氮平的精神分裂症稳定期患者突发恶心呕吐3 d,氯氮平血药浓度检测值为2826.54 ng/ml,经精神科急诊输液促代谢,对症支持等治疗1周后氯氮平血药浓度恢复正常,病情好转,转入精神科病房系统治疗。结合病史及相关检查,考虑氯氮平血药浓度升高可能与患者服用中成药肉蔻四神丸治疗大便失调及腹泻等有关。该药物含有多种成分均对细胞色素P450酶(cytochrome P450,CYP450)代谢有所影响,进而影响氯氮平的代谢,导致氯氮平血药浓度升高。希望通过报道此病例提醒医生在临床实践中应谨慎对待药物联用,氯氮平常规剂量治疗期间血药浓度异常升高时需要考虑多种药物之间的相互作用。This case report presents a patients with stable schizophrenia who abruptly vomited for three days during long-term treatment of clozapine.Laboratory tests revealed a blood clozapine concentration of 2826.54 ng/ml(three times higher than the warning threshold).The intoxication of clozapine was cured after a week of intensive psychiatric emergency care,including promoting metabolism-promotion infusion and symptomatic and supportive treatment.A comprehensive review of the patient'medical history,laboratory results,and symptoms led to the identification of the concurrent use of Roukou Sishen Wan,a traditional Chinese herbal medicine that modulated Bowel problems and diarrhea.Several components of Roukou Sishen Wan could interact with cytochrome P450(CYP450),potentially disturbing clozapine metabolism and causing the elevated blood clozapine concentration.Based on these findings,clinicians are strongly recommended to exercise caution when prescribing combination therapies.The drug interaction should be considered when encountering unexpectedly high blood clozapine levels during routine clozapine treatment with stable doses.

关 键 词：精神分裂症 氯氮平 细胞色素P450酶系统 药物浓度 肉蔻四神丸 

分 类 号：R749.3[医药卫生—神经病学与精神病学] R595.4[医药卫生—临床医学]