可能加重重症肌无力症状的药物

  Dr Stanly Freedman  张小凡译

这篇文章标题中最重要的词就是“可能”。正如重症肌无力的表现形式有很大的不同，肌无力患者对药物的敏感性也有很大的差异，事实上，非肌无力的健康人也面临同样的问题。因此，关于用药这里没有绝对的禁忌，除了一些用于麻醉的药物；当您正在服用或已服用下面所列的一种药物时，请不要有不必要的恐慌。如果您的重症肌无力症状控制得很好，这些药物很少会有不良反应，更重要的是请不要自己否认这些药物的正作用。决定是否服用这些药物时，请您务必事先咨询您的医生。我们需要着重强调的是虽然这些药物可以导致重肌无力症状加重，但除了penicillamine.(青霉胺)外，这些药物均不会影响重症肌无力的根本病程。

从医生的角度来看，问题的出现是由于药品的说明，药物手册与包奘上的说明不准确导致的。某些药物，例如temazepam(羟基安定)就是一个很好的例子，说明书上写重症肌无力患者是绝对禁忌，但事实上，它对重症肌无力完全没有影响。而另一方面，某些药物常可加重重症肌无力症状，但却没有警告提示。医生与患者面临的进一步的问题是，我们所可选用药物品种的多样性。例如，在英国，有至少15种不同的β-受体阻滞剂是获得许可使用的， 这些药物中的任何一种均可被不同的公司标记不同的商品名加以生产并上市出售。

在这篇文章里，我把药物根据他们的分类列表，并标明他们的“官方”名，（用黑体）和商品名（用斜体）。含有禁忌成分的复合制剂用括号加以标明。我试图列了一个关于他们如何影响重症肌无力的简短摘要。至于片剂和针剂，我仅列出的当地常用的剂型，当采用此途径给药时，可以达到身体能吸收的最大血药浓度。

1. ANTI-ARRHYTHMICS (抗心律失常)

These are used to treat and prevent irregular heart beat. The ones in this list have largely been superseded by newer, safer, drugs, including beta-blockers (see below).

• Procaine Amide(氨基普鲁卡因) Pronestyl
• Quinidine (奎纳定An optical isomer of quinine, extracted from the bark of the Cinchona tree and similar plant species. This alkaloid dampens the excitability of cardiac and skeletal muscles by blocking sodium and potassium currents across cellular membranes. It prolongs cellular action potential, and decreases automaticity. Quinidine also blocks muscarinic and alpha-adrenergic neurotransmission.)Kinidin Durules

2. ANTIBIOTICS (抗生素)

These are used to prevent and treat bacterial infections. One group A, which contains six members, affects transmission between nerve and muscle, and therefore can make MG worse. They are chiefly given by injection, and you are therefore most likely to come across them in hospital. You are more likely to encounter those in groups B, which are usually given as tablets, often for chest infections, but which are much less likely to upset your MG, and C, which are commonly used for bladder and kidney infections. Group D is now used very rarely.

• A.
• Gentamicin(庆大霉素) Genticin, Genticin Ear/Eye drops, Cidomycin Injection, Cidomycin Ear/Eye drops/ointment
• Amikacin(卡那霉素) Amikin
• Netilmicin(奈替霉素Semisynthetic 1-N-ethyl derivative of SISOMYCIN, an aminoglycoside antibiotic with action similar to gentamicin, but less ear and kidney toxicity.) Netillin
• Tobramycin(妥布霉素An aminoglycoside, broad-spectrum antibiotic produced by Streptomyces tenebrarius. It is effective against gram-negative bacteria, especially the Pseudomonas species. It is a 10% component of the antibiotic complex, NEBRAMYCIN, produced by the same species.) Nebcin
• Streptomycin(链霉素)
• Kanamycin(卡那霉素Antibiotic complex produced by Streptomyces kanamyceticus from Japanese soil. Comprises 3 components: kanamycin A, the major component, and kanamycins B and C, the minor components) Kannasyn
• B.
• Tetracycline(四环素An antibiotic originally produced by Streptomyces viridifaciens, but used mostly in synthetic form. It is an inhibitor of aminoacyl-tRNA binding during protein synthesis.) Achromycin, Sustamycin, Tetrabid, Tetrachel, Deteclo, (Mysteclin).
• Doxycycline(强力霉素A synthetic TETRACYCLINE derivative with similar antimicrobial activity. Animal studies suggest that it may cause less tooth staining than other tetracyclines. It is used in some areas for the treatment of chloroquine-resistant falciparum malaria (MALARIA, FALCIPARUM).) Nordox, Vibramycin,
• LimecyclineTetralysal 300
• Minocycline (二甲胺四环素A semisynthetic antibiotic effective against tetracycline-resistant staphylococcus infections.)Minocin MR
• Oxytetracycline(土霉素An antibiotic substance isolated from the actinomycete Streptomyces rimosus and used in a wide variety of clinical conditions.) Terramycin
• C.
• Ciprofloxacin(环丙沙星) Ciproxin
• Acrosoxacin (罗索沙星)Eradicin
• Cinoxacin(西诺沙星Synthetic antimicrobial related to oxolinic and nalidixic acids and used in urinary tract infections.) Cinobac
• Nalidixic Acid (萘啶酸A synthetic 1,8-naphthyridine antimicrobial agent with a limited bacteriocidal spectrum. It is an inhibitor of the A subunit of bacterial DNA gyrase.)Mictral, Negram, Uriben
• Norfloxacin (氟哌酸A synthetic fluoroquinolone (FLUOROQUINOLONES) with broad-spectrum antibacterial activity against most gram-negative and gram-positive bacteria. Norfloxacin inhibits bacterial DNA-gyrase.)Utinor
• Ofloxacin (氧氟沙星A synthetic fluoroquinolone (FLUOROQUINOLONES) antibacterial agent that inhibits the supercoiling activity of bacterial DNA gyrase, halting DNA replication.)Tarivid
• D.
• Polymixin B (多粘菌素B)
• Colistin (黏菌素Cyclic polypeptide antibiotic from Bacillus colistinus. It is composed of Polymyxins E1 and E2 (or Colistins A, B, and C) which act as detergents on cell membranes. Colistin is less toxic than Polymyxin B, but otherwise similar; the methanesulfonate is used orally.)Colomycin Injection

3. ANTI-MALARIALS(抗疟疾)

These drugs are sometimes also used to treat rheumatic conditions.

• Chloroquine (氯喹)Avloclor, Nivaquine
• Hydroxychloroquine(羟化氯喹A chemotherapeutic agent that acts against erythrocytic forms of malarial parasites. Hydroxychloroquine appears to concentrate in food vacuoles of affected protozoa. It inhibits plasmodial heme polymerase.) Plaquenil

4. ANTI-RHEUMATIC DRUGS(抗风湿药)

• Penicillamine (青霉胺3-Mercapto-D-valine. The most characteristic degradation product of the penicillin antibiotics. It is used as an antirheumatic and as a chelating agent in Wilson's disease.)Distamine, Pendramine.

5. ANTI-SPASMODICS(解痉药)

These drugs, which are used to relax and reduce the activity of the bladder and bowels, act by opposing the action of acetyl-choline (whereas drugs like mestinon promote it), and therefore carry a warning against their use in patients with MG. In fact, theoretically, they should not interfere with the action of acetyl-choline on muscle, and in practice there have been no reports of adverse effects in MG - perhaps because the warning has been so effective!

• Flavoxate (黄酮哌酯A drug that has been used in various urinary syndromes and as an antispasmodic. Its therapeutic usefulness and its mechanism of action are not clear. It may have local anesthetic activity and direct relaxing effects on smooth muscle as well as some activity as a muscarinic antagonist.)Urispas
• Oxybutinin (奥昔布宁)Cystrin, Ditropan
• Propantheline(普洛盘舍啉A muscarinic antagonist used as an antispasmodic, in rhinitis, in urinary incontinence, and in the treatment of ulcers. At high doses it has nicotinic effects resulting in neuromuscular blocking.) Probanthine

6. BETA-BLOCKERS(β-阻滞剂)

These drugs are used for the treatment of angina and other forms of heart disease, high blood pressure, migraine, and, occasionally, anxiety. They commonly produce a feeling of fatigue or muscle weakness, which tends to improve with continued treatment, and, rarely, have been reported to induce MG.

• Propranolol(心得安) Inderal, Angilol, Apsolol, Bedranol, Berkolol, Beta-Prograne, Cardinol, Propanix, (Inderetic, Inderex)
• Atenolol(阿替洛尔A cardioselective beta-adrenergic blocker possessing properties and potency similar to PROPRANOLOL, but without a negative inotropic effect.) Tenormin (Tenif, Tenoretic, Tenoret 50, Co-Tenidone), Atenix, Antipressan, Kalton, Totamol, (Beta-Adalat, Co-Tenidone, Totaretic)
• Acebutolol (醋丁洛尔A cardioselective beta-adrenergic antagonist with little effect on the bronchial receptors. The drug has stabilizing and quinidine-like effects on cardiac rhythm as well as weak inherent sympathomimetic action.)Sectral (Secadrex)
• Betaxolol (倍他洛尔)Kerlone
• Bisoprolol(比索洛尔A cardioselective beta-1-adrenergic blocker. It is effective in the management of hypertension and angina pectoris.) Emcor, Monocor, (Monozide)
• Carvedilol(卡维洛尔) Eucardic
• Celiprolol(塞利洛尔A cardioselective beta-1-adrenergic antagonist that may act as a partial agonist at some adrenergic sites.) Celectol
• Esmolol(艾司洛尔) Brevibloc
• Labetalol (拉贝洛尔Blocker of both alpha- and beta-adrenergic receptors that is used as an antihypertensive.)Trandate
• Metoprolol (美托洛尔A selective adrenergic beta-1-blocking agent with no stimulatory action. It's binding to plasma albumin is weaker than alprenolol and it may be useful in angina pectoris, hypertension, or cardiac arrhythmias.)Betaloc, Lopresor, (Co-Betaloc)
• Nadolol (纳多洛尔A non-selective beta-adrenergic antagonist with a long half-life, used in cardiovascular disease to treat arrhythmias, angina pectoris, and hypertension. Nadolol is also used for migraine and for tremor.)Corgard
• Oxprenolol(氧烯洛尔，心得平A beta-adrenergic antagonist used in the treatment of hypertension, angina pectoris, arrhythmias, and anxiety.) Trasicor, (Trasidrex)
• Pindolol (吲哚洛尔，心得乐A moderately lipophilic beta blocker (ADRENERGIC BETA-ANTAGONISTS). It is non-cardioselective and has intrinsic sympathomimetic actions, but little membrane-stabilizing activity.)Visken, (Viskaldix)
• Sotalol(甲磺胺心定，心得怡) Beta-Cardone, Sotacor, (Sotazide, Tolerzide)
• Timolol (噻吗洛尔A beta-adrenergic antagonist similar in action to PROPRANOLOL. The levo-isomer is the more active. Timolol has been proposed as an antihypertensive, antiarrhythmic, antiangina, and antiglaucoma agent. It is also used in the treatment of migraine and tremor.)Betim, Blocadren, (Moducren, Prestim, Timoptol Eye-drops).

7.DRUGS USED IN EPILEPSY(抗癫痫)

• Phenytoin (苯妥英)Epanutin

This is always listed among drugs which can precipitate MG, but actual reports of problems are rare.

8. DRUGS USED IN PSYCHIATRY(抗精神病)

A. Chlorpromazine and related drugs. (氯丙嗪及相关药物) These drugs are used in a wide variety of conditions. The original members of the group, chlorpromazepine and promazine, were reported to aggravate, or even to precipitate MG, but there are now a lot of newer analogues, and reports of trouble from these are rare. However it is probably still wise to use them cautiously.

• Chlorpromazine(氯丙嗪) Largactil
• Clozapine(氯氮平) Clozaril
• Flupenthixol(A thioxanthene neuroleptic that, unlike CHLORPROMAZINE, is claimed to have CNS-activating properties. It is used in the treatment of psychoses although not in excited or manic patients.) Depixol
• Fluphenazine(羟哌氟丙嗪A phenothiazine used in the treatment of psychoses. Its properties and uses are generally similar to those of CHLORPROMAZINE.) Moditen
• Loxapine (洛沙平An antipsychotic agent used in schizophrenia.)Loxapac
• Methotrimeprazine (左美丙嗪A phenothiazine with pharmacological activity similar to that of both CHLORPROMAZINE and PROMETHAZINE. It has the histamine-antagonist properties of the antihistamines together with CNS effects resembling those of chlorpromazine. )Nozinan
• Oxypertine (奥昔哌丁)
• Pericyazine(哌氰嗪) Neulactil
• Perphenazine(奋乃静An antipsychotic phenothiazine derivative with actions and uses similar to those of CHLORPROMAZINE.) Fentazin
• Pimozide (匹莫齐特，哌迷清A diphenylbutylpiperidine that is effective as an antipsychotic agent and as an alternative to HALOPERIDOL for the suppression of vocal and motor tics in patients with Tourette syndrome. Although the precise mechanism of action is unknown, blockade of postsynaptic dopamine receptors has been postulated. )Orap
• Prochlorperazine (普鲁氯嗪，丙氯拉嗪A phenothiazine antipsychotic used principally in the treatment of nausea, vomiting, and vertigo. It is more likely than CHLORPROMAZINE to cause extrapyramidal disorders. )
• Promazine(普马嗪A phenothiazine with actions similar to CHLORPROMAZINE but with less antipsychotic activity. It is primarily used in short-term treatment of disturbed behavior and as an antiemetic.) Sparine
• Risperidone(利派利酮A selective blocker of dopamine D2 and serotonin-5-HT-2 receptors that acts as an atypical antipsychotic agent. It has been shown to improve both positive and negative symptoms in the treatment of schizophrenia. ) Risperdal
• Sulpiride(舒必利A dopamine D2-receptor antagonist. It has been used therapeutically as an antidepressant, antipsychotic, and as a digestive aid. ) Dolmatil, Sulpitil
• Thioridazine Melleril
• Trifluoroperazine(三氟拉嗪 ) Stelazine
• Zuclopenthixol(氯哌噻吨 )Clopixol Acuphase

• B. Lithium(锂Salts of lithium are used in treating manic-depressive disorders ) Camcolit, Liskonum, Li-liquid, Litarex, Priadel.
• C.
• Phenelzine(本乙肼One of the MONOAMINE OXIDASE INHIBITORS used to treat DEPRESSION; PHOBIC DISORDERS; and PANIC. ) Nardil,
• Isocarboxazid(异卡波肼An MAO inhibitor that is effective in the treatment of major depression, dysthymic disorder, and atypical depression. It also is useful in the treatment of panic disorder and the phobic disorders. ) Marplan
• Tranylcypromine (反苯环丙胺A propylamine formed from the cyclization of the side chain of amphetamine. This monoamine oxidase inhibitor is effective in the treatment of major depression, dysthymic disorder, and atypical depression. It also is useful in panic and phobic disorders. )Parnate, (Parstelin)

9. MUSCLE RELAXANTS（肌松剂）

These drugs are designed to cause muscle paralysis and are used almost exclusively by anaesthetists. For this reason, I consider it unnecessary to list them individually. There are two classes of muscle-relaxants: curare-like drugs, which must not be used in MG, and depolarising relaxants, which can sometimes be used. Both types must be distinguished from drugs such as the minor tranquillisers, which are often called "muscle-relaxants", although their effects are entirely non-specific

[感谢小凡的翻译,作者主要针对英国的经验来谈,供大家参考].

http://www.9b01.net/zzjwl/ShowPost.asp?action=Previous&id=1352  也建议大家看看这里

谢谢海蓝!

  小凡医生,美林布洛芬混悬液可以用吗?我经常头痛,一般都是感冒引起的.如果不能用,那用什么药好呢?谢谢!

小凡医生很忙,不多上论坛,建议你楼上的你发电子邮件咨询.

小凡:zhangxiaofan97@yahoo.com.cn

张小帆医生是武汉同济医院的医生，她很好的。去年我写信给扬明山主任，是小帆医生回的电话，她将上述药物给我念了一遍，还叫我记下了，原来这文章还是她翻译的啊，谢谢她！

好人一生平安！

仁心仁術

受益

我姐姐今年36岁 ，1986年因为胸腺瘤引起的重症肌无力曾经在南京军区医院做了胸腺瘤切除手术，术后恢复的也不错，但是现在因为乳腺瘤需要手术治疗，但是我们所在的大连的医院因为没有能力处理手术可能引发的并发症而拒绝为我姐姐手术，现在希望得到国内有能力做相关手术的医院和专家的帮助为其治疗，希望有这方面信息的朋友帮助联系一下，我的电话是13500700805！