文拉法辛与去甲文拉法辛致低钠血症文献分析

Literature analysis of hyponatremia induced by venlafaxine and desvenlafaxine

目的:探讨文拉法辛与去甲文拉法辛致低钠血症的特征与规律,为临床安全用药提供参考。方法:检索中国知网、万方、维普、PubMed、Embase数据库,收集文拉法辛与去甲文拉法辛致低钠血症的个案报道,对患者的一般情况、药物使用情况、低钠血症发生时间、临床表现、治疗及转归等进行统计分析。结果:共纳入24篇文献,涉及24例患者,其中女性15例(62.50%)、男性9例(37.50%),60岁以上患者16例(66.67%);文拉法辛中位使用剂量为75 mg·d^(-1)。低钠血症多发生于用药后4周(66.67%),累及系统/器官以中枢及外周神经系统(57.44%)和胃肠系统(21.28%)为主,临床表现主要包括意识模糊、嗜睡、癫痫、恶心等。患者平均血钠为118 mmol·L^(-1),常见的危险因素包括高龄、女性、联用其他致低钠血症的药物。所有患者经治疗后均好转。结论:临床应重视文拉法辛与去甲文拉法辛导致低钠血症的风险,避免危险因素,对存在危险因素的患者用药后4周内进行随访监测,确保患者用药安全。

Objective:To investigate the characteristics and regularity of hyponatremia induced by venlafaxine and desvenlafaxine in order to provide references for safety drug use in clinic.Methods:Case reports of hyponatremia induced by venlafaxine and desvenlafaxine were retrieved from databases including CNKI,Wanfang,VIP,PubMed and Embase,and were analyzed statistically in terms of general information,drug use of patients,occurrence time of hyponatremia,clinical manifestations,treatment and outcome.Results:A total of 24 papers,24 cases were enrolled.There were 15 females (62.50%) and 9 males (37.50%),and 16patients (66.67%) were over 60 years old.The median dose of venlafaxine was 75 mg·d^(-1).Hyponatremia mostly occurred within 4weeks after administration (66.67%).The systems/organs involved in ADR were mainly central and peripheral nervous system (57.44%)and gastrointestinal system (21.28%).The clinical manifestations mainly included confusion,lethargy,epilepsy,nausea and so on.The average level of serum sodium of the patients was 118 mmol·L^(-1).The most common risk factors were old age,female,concomitant use of other hyponatremia-risk drugs.All patients recovered after treatment.Conclusion:Attentions should be paid to the risk of hyponatremia induced by venlafaxine and desvenlafaxine.The risk factors should be avoided and follow-up should be strengthened for high-risk patients in 4 weeks after the use of venlafaxine and desvenlafaxine,so as to ensure the safety drug use of patients.