伪麻黄碱中毒：临床症状的性别特异性差异

文献信息

中文摘要

背景： 伪麻黄碱（PSE）是一种间接作用的拟交感神经药，在全球范围内用于治疗感冒和流感症状以及过敏性鼻炎。在德国，PSE仅作为与其他活性成分（如乙酰水杨酸、对乙酰氨基酚、布洛芬以及第一代和第二代H1受体拮抗剂）组成的复方产品提供。尽管PSE广泛可得且使用频繁，但该活性成分屡次与严重药物不良反应（ADR）相关联。最近，在2024年，在确立PSE使用与脑灌注不足发生之间的关联后，发布了一封红色警告信。此外，该药物并非总是按照指南用于治疗特定症状，还因其间接拟交感作用而被滥用。本研究包括对文献中已发表的PSE中毒病例的分析。为此，在PubMed中进行了系统性文献检索，从总共81篇病例报告中提取了118例患者病例。随后对各个病例进行了多方面分析。美国在病例报告数量上居首，其次是英国。所分析的患者病例在性别和症状方面显示出差异。心血管事件主要发生在男性中，而胃肠病学和皮肤病学症状主要发生在女性中。为降低PSE中毒风险，需要医生和药师加强教育努力。此外，检查禁忌症可以降低风险。关于PSE的教育也可以通过信誉良好的在线平台提供。本研究强调了PSE中毒的临床相关性及其广泛的症状范围。

英文摘要

Pseudoephedrine (PSE) is an indirectly acting sympathomimetic agent used worldwide to treat cold and flu symptoms, as well as allergic rhinitis. In Germany, PSE is available exclusively as a combination product with other active ingredients such as acetylsalicylic acid, paracetamol, ibuprofen, and first- and second-generation H1 receptor antagonists. Despite the widespread availability and frequent use of PSE, the active ingredient has repeatedly been linked to serious adverse drug reactions (ADRs). Most recently, in 2024, a red-hand letter was circulated after a link was established between PSE use and the occurrence of cerebral hypoperfusion. Furthermore, the drug is not always used in accordance with guidelines for treating specific symptoms but is also misused due to its indirect sympathomimetic effect. This study includes an analysis of published PSE intoxication cases from the literature. To this end, a systematic literature search was conducted in PubMed, from which 118 patient cases were extracted from a total of 81 case reports. The individual cases were then analyzed with regard to various aspects. The United States was the leading country in terms of case reports, followed by the United Kingdom. The analyzed patient cases show differences in terms sex and symptoms. Cardiovascular events occurred predominantly in men, while gastroenterological and dermatological symptoms occurred predominantly in women. To reduce the risk of PSE poisoning, increased educational efforts by physicians and pharmacists are necessary. Furthermore, checking for contraindications could reduce the risk. Education about PSE could also be provided through reputable online platforms. This study highlights the clinical relevance of PSE poisoning and the wide range of symptoms.