羟考酮与普瑞巴林相互作用致精神异常

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1例51岁男性患者因鼻咽癌放、化疗后副鼻窦炎行手术治疗,术前术后均给予氨酚羟考酮(每片含盐酸羟考酮5 mg,对乙酰氨基酚325 mg)1片口服、3次/d。因镇痛效果不佳,加用普瑞巴林75 mg口服、2次/d。期间患者家属曾自行为其加服盐酸羟考酮10 mg口服、1次/d,共用2 d。加用普瑞巴林2 d后,患者突发谵妄、烦躁、四肢不自主抽搐、认知障碍、定向障碍等精神异常。停用上述镇痛药物,给予右美托咪定镇痛、镇静。3 d后,患者精神状态好转,无明显谵妄,辨别力及定向力恢复正常,停用右美托咪定。患者精神失常的出现及消退与联用镇痛药物有明显时间相关性,结合以往文献,考虑该例患者精神失常为羟考酮与普瑞巴林相互作用所致。“,”A 51-year-old male patient received an operation treatment for paranasal sinusitis induced by radiotherapy and chemotherapy of nasopharyngeal carcinoma. One oxycodone and acetaminophen tablet (each tablet contains oxycodone hydrochloride 5 mg and acetaminophen 325 mg) was given orally thrice daily before and after the operation. Pregabalin 75 mg twice daily was added because of the poor analgesic effectiveness. During the treatment, oral oxycodone hydrochloride 10 mg was given once daily by his family members for 2 days. Two days after the addition of pregabalin, the patient developed mental disorders, such as delirium, irritability, involuntary convulsions of limbs, cognitive impairment, and disorientation. All above-mentioned analgesics were discontinued and dexmedetomidine was given for pain relief and sedation. Three days later, the mental state of the patient was improved, there was no obvious delirium, the discrimination and orientation returned to normal, and dexmetomidine was discontinued. There was an obvious time correlation between the occurrence and disappearance of mental disorders and the combination of analgesic drugs. Referring to the previous literature, it was considered that the mental disorders of the patient were caused by the interaction between oxycodone and pregabalin.
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