化療前止吐藥Dexamethasone引起嚴重打嗝改用Methylprednisolone後得到改善

Improvement of Dexamethasone-Induced Hiccup by Replacement with Methylprednisolone in a Patient Receiving Chemotherapy

10.6168/FJCP.2017.2504.10

陳弘益(Hung-Yi Chen)；林文亮(Wen-Liang Lin)；許美英(May-Ying Hsu)；葉鳳英(Feng-Ying Yeh)

止吐藥 ； 打嗝 ； Dexamethasone ； Methylprednisolone ； Antiemetics ； Hiccup ； Dexamethasone ； Methylprednisolone

臺灣臨床藥學雜誌

25卷4期（2017 / 10 / 31）

346 - 351

繁體中文

本文報導一位62歲男性，罹患糖尿病、高血壓、慢性腎功能不全及橫結腸第三期大腸癌。病人每二週接受leucovorin、fluorouracil及oxaliplatin化學治療。前四次化療結束後病人即出現打嗝，每次持續約兩天，且打嗝時引起胃酸逆流。第五次化療時，以methylprednisolone替代化療前止吐藥dexamethasone；此次化療後打嗝時間明顯縮短，僅在進食時短暫打嗝，飯後即停止，且無胃食道逆流症狀，但返家有噁心感維持2天。此後化療前止吐藥均使用methylprednisolone，第6 ~ 9次化療後無打嗝，但返家後噁心感維持數天，第10次化療返家後噁心感維持7天，有手腳麻現象，第11次返家後曾有腹部悶痛。六個月後，病人接受leucovorin、fluorouracil及irinotecan治療，止吐藥採用dexamethasone，又發生嚴重打嗝。本案例以Naranjo Algorithm評分為9分，判斷打嗝確定是dexamethasone引起。

A 62-year-old man was diagnosed as stage 3 transverse colon cancer and received FOLFOX chemotherapy (leucovorin, fluorouracil and oxaliplatin) every two weeks. He suffered from hiccup after chemotherapy at cycles of 1 ~ 4 with dexamethasone as the antiemetics. The hiccup lasted about two days after each cycle and caused gastroesophageal reflux. At the fifth cycle of chemotherapy, dexamethasone was replaced by methylprednisolone and the hiccup was much improved compare to first 4 cycles. He didn't develop any hiccup but nausea with methylprednisolone at cycles of 6 ~ 11. Six months later, the patient received FOLFIRI chemotherapy (leucovorin, fluorouracil and irinotecan) with dexamethasone as the antiemetics, and severe hiccup happened again. Causality assessment with Naranjo algorithm was definite (9 points) for this case.