社團法人臺灣臨床藥學會

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【案例報告】化療前止吐藥Dexamethasone 引起嚴重打嗝改用Methylprednisolone 後得到改善
Improvement of Dexamethasone-Induced Hiccup by Replacement with Methylprednisolone in a Patient Receiving Chemotherapy
止吐藥、打嗝、Dexamethasone、Methylprednisolone、Antiemetics, Hiccup, Dexamethasone, Methylprednisolone
陳弘益Hung-Yi Chen*  、林文亮Wen-Liang Lin  、許美英May-Ying Hsu  、葉鳳英Feng-Ying Yeh
1國立成功大學醫學院附設醫院藥劑部
本文報導一位62 歲男性,罹患糖尿病、高血壓、慢性腎功能不全及橫結腸第三期大腸癌。病人每二週接受leucovorin、fluorouracil 及oxaliplatin 化學治療。前四次化療結束後病人即出現打嗝,每次持續約兩天,且打嗝時引起胃酸逆流。第五次化療時,以methylprednisolone 替代化療前止吐藥dexamethasone;此次化療後打嗝時間明顯縮短,僅在進食時短暫打嗝,飯後即停止,且無胃食道逆流症狀,但返家有噁心感維持2 天。此後化療前止吐藥均使用methylprednisolone,第6 ~ 9 次化療後無打嗝,但返家後噁心感維持數天,第10 次化療返家後噁心感維持7 天,有手腳麻現象,第11 次返家後曾有腹部悶痛。六個月後,病人接受leucovorin、fluorouracil 及irinotecan 治療,止吐藥採用dexamethasone,又發生嚴重打嗝。本案例以NaranjoAlgorithm 評分為9 分,判斷打嗝確定是dexamethasone 引起。
 
A 62-year-old man was diagnosed as stage 3 transverse colon cancer and received FOLFOX chemotherapy (leucovorin, fluorouracil and oxaliplatin) every two weeks. He suffered from hiccup after chemotherapy at cycles of 1 ~ 4 with dexamethasone as the antiemetics. The hiccup lasted about two days after each cycle and caused gastroesophageal reflux. At the fifth cycle of chemotherapy, dexamethasone was replaced by methylprednisolone and the hiccup was much improved compare to first 4 cycles. He didn’t develop any hiccup but nausea with methylprednisolone at cycles of 6 ~ 11. Six months later, the patient received FOLFIRI chemotherapy (leucovorin, fluorouracil and irinotecan) with  examethasone as the antiemetics, and severe hiccup happened again. Causality assessment with Naranjo algorithm was definite (9 points) for this case.
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