老年患者使用氯巴唑的注意事项

IF 0.6 Q3 Medicine

Indian Journal of Otolaryngology and Head and Neck Surgery Pub Date : 2023-05-15 DOI:10.18231/j.ijashnb.2023.007

Divya KP, A. Cherian, Aswin R M

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引用次数: 0

摘要

氯巴唑是一种较新的苯二氮卓类药物，现在广泛用作局灶性癫痫的第一种辅助治疗。一位67岁的糖尿病和高血压患者，一年前有额部挫伤病史，表现为丛集性癫痫发作。他开始服用氯巴唑20毫克，左乙拉西坦1000毫克/天。癫痫复发促使氯巴唑剂量增加至40毫克/天。患者发展为肝性脑病，其失代偿可能与使用大剂量氯巴唑有关。因此，氯巴唑随着肝性昏迷前治疗方案和其他支持措施逐渐减少，导致平静的恢复。老年和衰弱患者或器质性脑综合征患者服用氯巴唑时必须谨慎，因为他们更容易受到苯二氮卓类药物中枢神经系统(CNS)抑制剂活性的影响。由于氯巴唑在结合前需要脱烷基和羟基化，因此对肝脏受累的患者应谨慎使用。

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Caution in usage of clobazam in elderly patients

Clobazam, one of the newer benzodiazepines, is now used extensively as first add on therapy in focal epilepsy.A 67-year-old diabetic and hypertensive gentleman with a history of frontal contusion one year ago, presented with clustering of seizures. He was started on clobazam 20 mg, and levetiracetam 1000 mg/day. Recurrence of seizures prompted a dose escalation of clobazam to 40 mg/day. The patient developed hepatic encephalopathy and his decompensation was probably precipitated by the use of high dose of clobazam. Clobazam was thus gradually tapered off along with hepatic precoma regimen, and other supportive measures leading to an uneventful recovery.Caution must be taken while administering clobazam to elderly and debilitated patients or those with organic brain syndrome as they are more prone to the central nervous system (CNS) depressant activity of benzodiazepines. Since clobazam requires dealkylation and hydroxylation prior to conjugation, it should be used with caution in patients with hepatic involvement.

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来源期刊

Indian Journal of Otolaryngology and Head and Neck Surgery Medicine-Otorhinolaryngology

CiteScore

0.90

自引率

0.00%

发文量

226

审稿时长

3 months

期刊介绍： Indian Journal of Otolaryngology and Head & Neck Surgery was founded as Indian Journal of Otolaryngology in 1949 as a scientific Journal published by the Association of Otolaryngologists of India and was later rechristened as IJOHNS to incorporate the changes and progress. IJOHNS, undoubtedly one of the oldest Journals in India, is the official publication of the Association of Otolaryngologists of India and is about to publish it is 67th Volume in 2015. The Journal published quarterly accepts articles in general Oto-Rhino-Laryngology and various subspecialities such as Otology, Rhinology, Laryngology and Phonosurgery, Neurotology, Head and Neck Surgery etc. The Journal acts as a window to showcase and project the clinical and research work done by Otolaryngologists community in India and around the world. It is a continued source of useful clinical information with peer review by eminent Otolaryngologists of repute in their respective fields. The Journal accepts articles pertaining to clinical reports, Clinical studies, Research articles in basic and applied Otolaryngology, short Communications, Clinical records reporting unusual presentations or lesions and new surgical techniques. The journal acts as a catalyst and mirrors the Indian Otolaryngologist’s active interests and pursuits. The Journal also invites articles from senior and experienced authors on interesting topics in Otolaryngology and allied sciences from all over the world. The print version is distributed free to about 4000 members of Association of Otolaryngologists of India and the e-Journal shortly going to make its appearance on the Springer Board can be accessed by all the members. Association of Otolaryngologists of India and M/s Springer India group have come together to co-publish IJOHNS from January 2007 and this bondage is going to provide an impetus to the Journal in terms of international presence and global exposure.