Introduction: This report describes a case of hyperactive delirium induced by tapenatadol whose symptoms were successfully managed with opioid-switching to oxycodon. Case: A 67-year-old female, who had been treated with chemotherapy for malignant thymoma, had to stop chemotherapy because of her carcinomatous pericarditis. Tapentadol 200 mg per day was administrated for her unbearable chest wall tumor invasion-related somatic pain. After a while, insomnia, visual hallucination, thought disturbance, and attention disturbance were appeared. We diagnosed as hyperactive delirium. Because her somatic pain was favorably controlled by tapentadol, we additionally administered quetiapine 50 mg per day instead of replacing tapentadol. Unfortunately, quetiapine was not effective for the delirium. We therefore switched opioids from tapentadol to oxycodon. The delirium was remitted soon after the switching without relapsing of the pain. Conclusion: Tapentadaol reportedly induce hyperactive delirium via its noradrenaline reuptake inhibitory action. This case suggests that switching tapenatadol to other opioid could be an effective option for opioid induced delirium.

Purpose: Hiccups are a symptom that often appear in lung cancer patients during medical treatment. Although various drugs and non-pharmacologic therapies are used to treat them, they often are not effective. We report 2 cases of successful treatment for refractory hiccups due to chemotherapy for lung cancer using pregabalin. Case report: Both patients had advanced squamous lung cancer. That in case 1 was treated using chemotherapy with carboplatin and paclitaxel, while the case 2 received nedaplatin and irinotecan. Hiccups occurred and became exacerbated during chemotherapy in both, and were considered to be induced by the anticancer drugs. Separate treatments with metoclopramide, chlorpromazine, and gabapentin did not have any effect, whereas immediate improvement was seen after taking pregabalin in both cases. Conclusion: Pregabalin, often used as an adjuvant analgesic, controls excessive neuronal excitement. In the present cases, effective relief of refractory hiccups was seen.