Meperidine與選擇性血清素再回收抑制劑

Meperidine and Selective Serotonin-Reuptake Inhibitors

Meperidine is one of the most commonly used opioid for the relief of acute pain. However, this full opioid-agonist may also cause several adverse effects related to its pharmacological actions, including the less-recognized serotonin syndrome. Theoretically, through blocking presynaptic serotonin reuptake, meperidine may induce or interact with other serotonergic agents and result in serotonin hyperstimulation. There is an increased risk for serotonin syndrome in susceptible individual or in patients with two or more serotonin reuptake-inhibiting medications used together. Sometimes, medications like meperidine are not immediately identified as serotonergic, and are added to a patient's regimen for analgesia. Serotonin syndrome is serious and poses a potentially life-threatening risk. Cautious prescription of meperidine and heightened physician awareness of this syndrome may prevent unexpected complications. Clinicians may underestimate the potential for selective serotonin reuptake inhibitors (SSRis) and newer serotonergic medications to cause serious morbidity. Serotonergic agents should not be used with meperidine-type analgesics to avoid the potential consequences. Morphine has no serotonergic property, therefore should be considered as an alternative analgesic.

Meperidine是一個最普遍使用的嗎啡類急性疼痛止痛劑，但是，此嗎啡受體促動劑也可能導致若干藥理學的不良反應，包括不易辨識的血清素症候群。理論上，透過阻止 於突觸間隙前的血清素再吸收，meperidine可能誘發或與其他促血清素藥物互動導致血清素起量刺激。對於一些敏感的人或同時服用兩種以上選擇性血清素再回收抑制劑的病患，會有提高血清素症候群的機率的風險。有時，meperidine不會立即被認出是屬於促血清素藥物，而加入病人的止痛療程。血清素症候群是嚴重而有可能威脅生命的，臨床醫生可能低估對選擇性血清素再回收抑制劑和新型促血清素藥物的潛在危險，導致嚴重罹病。因此，謹慎的處方使用meperidine及提高醫師對血清素症候群的暸解，可阻止意外的併發症。促血清素藥物不應和meperidine類型的止痛劑一同使用，以避免潛在的後果。嗎啡沒有促血清素藥物特性，因此應該作為替代止痛劑。