緩和医療13巻1号 pp
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1 Palliative Care Research 2015; 10(3): Palliat Care Res 2018; 13(1): 患者は 68 歳男性で, 左甲状腺腫瘍未分化転化の診断でレンバチニブを内服中, 左鎖骨周囲の腫脹, 疼痛がありトラマドールを内服開始した.2 日後から下痢, 発汗, 見当識障害, ミオクローヌスなどが認められたためセロトニン症候群と診断された. さらに手足が動く, 体幹をくねらせるなどのジスキネジアがみられた. トラマドールを内服中止したところ, 半日でミオクローヌスとジスキネジアは軽快し, 翌日には消失した. 有害事象発現時における薬剤の時間的関連性から原因はトラマドールであると考えられた. トラマドールはセロトニン再取り込み阻害作用を有するため, セロトニン症候群を引き起こす可能性はあるものの, 報告は少なく, ジスキネジア合併の報告はない. トラマドール使用時には, ジスキネジア症状を含む, セロトニン症候群の出現に留意が必要である. Palliat Care Res 2018; 13(1): Key words: トラマドール, セロトニン症候群, ジスキネジア, がん性疼痛 緒言 Tramadol hydrochloride: TRM WHO 3 2 疼 疼 疼 TRM Corresponding Author TEL FAX momoka-s@asahikawa-med.ac.jp 症例提示 68 C
2 Palliative Care Research 表 1 臨床経過 Dose mg/day Day TRM TRM Day AST U/L ALT U/L Cre mg/dl Na Meq/L K Meq/L Cl Meq/L Ca 2+ mg/dl mg/ Day 1 1 Day mg/ Day 7 疼 50 mg/ Day mg/ Day 9 疼 TRM 100 mg/ 12.5 mg/ Day 10 TRM 200 mg/ 25 mg/ Day 12 TRM 100 mg/ Day 11 Day 12 Day 13 TRM 疼 30 mg/ 2.5 mg/ 疼 考察 TRM 1 2 TRM M1 6 TRM Hegerl 3 Hegerl 9 110
3 トラマドールによるセロトニン症候群, ジスキネジア 表 2 セロトニン症候群 Hegerl らの診断基準 < / 3 4 / TRM 4 5 TRM CYP2D6 CYP2D6 111
4 Palliative Care Research CYP2D6 CT TRM 疼 0.3 疼 6,7 TRM 100 mg/ TRM mg TRM 1 1 TRM 5-HT 2A 8 TRM TRM TRM 9 結語 TRM 1 TRM 文献 1 : 2010; pdf : 2009; dl/tp1122-1c21.pdf Hegerl U, Bottlender R, Gallinat J, et al. The serotonin syndrome scale: first results on validity. Eur Arch Psychiatry Clin Neurosci 1998; 248: Takeshita J, Litzinger MH. Serotonin syndrome associated with tramadol. Prim Care Companion J Clin Psychiatry 2009; 11: ; 36: Hsu SK, Yeh CC, Lin CJ, et al. An open label trial of the effects and safety profile of extended-release tramadol in the management of chronic pain. Acta Anaesthesiol Taiwan 2012; 50: Yoshizawa K, Kawai K, Fujie M, et al. Overall safety profile and effectiveness of tramadol hydrochloride/acetaminophen in patients with chronic noncancer pain in Japanese realworld practice. Curr Med Res Opin 2015; 31: Kapur S, Remington G. Serotonin-dopamine interaction and its relevance to schizophrenia. Am J Psychiatry 1996; 153: ; 6:
5 Serotonin syndrome with acute dyskinesia due to tramadol hydrochloride Case Report A Patient with Cancer Pain Developing Serotonin Syndrome and Concomitant Acute Dyskinesia Associated with Tramadol Hydrochloride Momoka Iwayama, 1) Yasushi Abe, 2) Takayuki Kunisawa, 2,3) and Yoshikazu Tasaki 1) 1)Department of Pharmacy and Pharmacology, Asahikawa Medical University Hospital, 2)Department of Palliative Care, Asahikawa Medical University Hospital, 3)Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University A 68-year-old man with a diagnosis of transformation to undifferentiated carcinoma of the left thyroid who was being treated with Lenvatinib presented with swelling and pain around the left clavicle, and tramadol was started. Two days later, he developed diarrhea, sweating, disorientation, and myoclonus, leading to a diagnosis of serotonin syndrome. He also exhibited dyskinesia including involuntary movements of the arms and legs and squirming movements of the trunk. Tramadol was thus discontinued. His myoclonus and dyskinesia resolved within half a day and had disappeared the day after tramadol discontinuation. These symptoms were attributed to tramadol because there was a reasonable temporal relationship between drug administration and the adverse event. Tramadol inhibits serotonin reuptake, and thus has the potential to cause serotonin syndrome. However, there have been relatively few reports describing the occurrence of this syndrome, and there have been none showing concomitant dyskinesia. Clinicians should be aware that tramadol can cause serotonin syndrome accompanied by dyskinesia. Palliat Care Res 2018; 13(1): Key words: tramadol, serotonin syndrome, dyskinesia, cancer-associated pain 113
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