Severe Neurotoxicity in a Hemodialysis Patient: An Unrecognized Culprit of Gabapentin

Gabapentin在尿毒透析病患表現的神經症狀

吳欣吉(Hsin-Chi Wu) ； 林裕華(Yuh-Feng Lin) ； 林石化(Shih-Hua Lin)

《Acta Nephrologica》 22卷2期 (2008/06) Pp. 128-130

摘要

鎮頑癲(Gabapentin)已被用來治療癲癇以及神經痛，主要山腎臟排除。其引發之神經毒性具有相當的生命危險卻鮮少為人所認知，尤其是在腎臟功能不好的病人身上使用。我們提出一位75歲的尿毒透析病患因為帶狀皰疹神經疼痛而使用鎮頑癲（每天三次、一次300毫克，共1800毫克）後產生言語混亂、意識不清及昏迷。實驗室檢查包括血糖、肝功能、電解質、血氨值都在正常範圍內，腦部電腦斷層檢查並無急性腦血管梗塞、出血。立即停止藥物並且緊急地施予4小時之高廓清血液透析快速地矯正她的神經學症狀。因為鎮頑癲目前愈來愈廣泛地被使用，所以在腎功能不佳的病患身上使用鎮頑癲的劑量必須要謹慎調整。快速地診斷腎功能異常病患的鎮頑癲神經毒性以及快速地移除掉過量的藥物可避免嚴重的併發症產生。

關鍵字

鎮頑癲 ； 血液透析 ； 神經毒性 ； 癲癇 ； 尿毒症

並列摘要

Gabapentin, eliminated entirely by kidneys, has been currently documented as one of effective therapy for epilepsy and neuropathic pain. However, gahapentin-induced neurotoxicity is still a less-recognized but life-threatening complication, especially in patients with impaired renal function. We describe a 75-year-old uremic patient who developed incoherent speech, progressive confusion, and coma after gabapentin treatment (300 mg thrice a day, total 1800 mg) for herpetic neuralgia post hemodialysis. Laboratory data including plasma glucose, liver functions, electrolytes, and ammonia level acre within normal range, computed tomography (CT) of brain did not show any acute infarction, hemorrhage, or other organic lesions. Prompt initiation of high-flux hemodialysis for 4 hours coupled with the withdrawal of gabapentin dramatically reversed her neurological features, supporting the gabapentin-induced neurotoxicity. The dose of gabapentin must be cautiously adjusted in patients with impaired renal junction. Early recognition of gabapentin-associated neurotoxicity with rapid elimination of gabapentin will avoid catastrophic complications in patients with advanced renal failure.

並列關鍵字

gabapentin ； hemodialysis ； neurotoxicity ； seizure ； uremia