Drug accumulation and coma caused by the combination of donepezil and memantine
10.3760/cma.j.cn114015-20230613-00429
- VernacularTitle:多奈哌齐和美金刚联用致药物蓄积并昏迷
- Author:
Na ZHAO
1
;
Wei LIU
;
Yanqi CHU
Author Information
1. 北京市西城区广外医院药剂科，北京 100055
- Publication Type:Journal Article
- Keywords:
Coma;
Alzheimer disease;
Aged;
Donepezil;
Memantine;
Drug accumulation
- From:
Adverse Drug Reactions Journal
2024;26(3):188-190
- CountryChina
- Language:Chinese
-
Abstract:
An 87-year-old female patient with Alzheimer's disease received donepezil 5 mg once daily orally for 8 years and then memantine 10 mg once daily orally was added due to the progression of the condition. Three months later, the patient suddenly fell into a coma and did not respond to call, acompanied by shortness of breath and wheezing. The patient had needle like changes in the pupils of both eyes, with blood pressure 190/100 mmHg and heart rate 56 beats per minute. The Glasgow Coma Scale (GCS) was E1V1M1. It was considered that the patient was poisoned due to drug accumulation caused by combination use of donepezil and memantine (blood concentration of methotrexate 215 mg/L, warning value: 30 mg/L; blood concentration of donepezil 33 mg/L, warning value: 20 mg/L). The 2 drugs were stopped, and symptomatic and supportive treatments such as fluid hydration, blood pressure reduction, and brain awakening were given. On the 3th day after drug discontinuation, the patient′s consciousness temporarily shifted to drowsiness, and her GCS was E1V1M1; on the 7th day after drug discontinuation, the patient′s consciousness became clear and she was able to answer simple questions, with GCS E4V4M4, blood pressure 126/67 mmHg, and normal pupil size.
