用藥安全 Drug Safety 註表一市售感冒糖漿成份一覽表 ( 每 1 ml 含量 ) Acetaminophen Chlorpheniramine dl-methylephedrine Caffeine Guaiacol Carbetapentane Dextromethorphan 15 m

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1 Drug Safety 用藥安全 感冒糖漿併用提神飲料引起心臟不良反應之案例報告 高雄醫學大學附設中和紀念醫院藥劑部藥師曾雅聘 弘興藥局藥師黃芬民 摘要 63 壹 前言 () () ( ) 281 Mar 藥學雜誌第 110 冊 125

2 用藥安全 Drug Safety 註表一市售感冒糖漿成份一覽表 ( 每 1 ml 含量 ) Acetaminophen Chlorpheniramine dl-methylephedrine Caffeine Guaiacol Carbetapentane Dextromethorphan 15 mg 0.21 mg 0.48 mg 1.8 mg 3 mg 0.48 mg mg 0.07 mg 0.27 mg 1.00 mg 1.6 mg mg - 10 mg 0.1 mg 0.4 mg 1.25 mg 2.5 mg mg 0.12 mg 0.5 mg 1.5 mg mg 0.12 mg 0.48 mg 1.8 mg 3 mg 0.48 mg 0.5 mg 10 mg mg 0.5 mg 1.5 mg mg mg 0.08 mg 0.33 mg 1 mg mg 0.12 mg mg 1.5 mg 2.4 mg mg mg mg 1.8 mg mg 0.12 mg 0.48 mg 1.5 mg 3 mg mg 0.12 mg 0.48 mg 1.5 mg 3 mg mg 0.08 mg 0.33 mg 1.0 mg mg mg 0.49 mg 1.8 mg mg 0.12 mg 0.48 mg 1.5 mg 3 mg mg mg mg mg mg mg 0.07 mg mg 1.25 mg mg 7.5 mg 0.06 mg mg 0.75 mg mg 0.06 mg mg 0.75 mg mg mg 0.08 mg 0.33 mg 1 mg 1.66 mg mg 0.12 mg mg 1.5 mg 2.49 mg mg mg 0.5 mg 1.5 mg 2.83 mg mg mg 1.04 mg 3.2 mg 4.2 mg mg 0.04 mg mg 0.5 mg 0.83 mg - 表二市售提神飲料成份一覽表 ( 每 100 ml 含量 ) B1 B2 B6 B12 C () 0.56 mg mg µg 8.4 mg 12.5 mg 25 mg ppm 14 g 160 ml 200P 0.2 mg 0.7 mg 0.8 mg mg 150 mg 13.8 g 200 ml - 22 mg 1.1 mg mg 300 mg 12 g 100 ml 0.1 mg mg mg 0.5 mg 4 mg ml V - V ˇ 500 mg 50 ppm ml 1.1 mg 1.5 mg 2.2 mg 3 µg mg ml EX Red Bull - - V V ˇ V - V ml V THE JOURNAL OF TAIWAN PHARMACY Vol.28 No.1 Mar

3 表三各式飲料咖啡因含量 mg/150 cc mg/150 cc mg/ mg/ 貳 案例報告 mg mg mmhg 101 mmhg135 captopril (Capoten) /92 mmhg 96 / 表四病人於急診心跳血壓之變更及處置 / / 19:18 161/ captopril 25 mg 1#/SL 20:30 176/ :15 163/ :25 177/ nifedipine 10 mg 1#SL / / 23:20 148/ :45 145/ Naranjo score 7 ( ) 表五 Naranjo scale 評分表 () :00 143/ captopril 25 mg 3#, tid 參 討論 281 Mar 藥學雜誌第 110 冊 127

4 用藥安全 Drug Safety 1,7 Caffeine Chlorpheniramine dl-methylephedrine 8 表六市售感冒糖漿成份及劑量適應症一覽表 Acetaminophen 500 mg-1g q4-6h 4 g/day (mg) Chlorpheniramine 4 mg q4-6h dl-methylephedrine mg tid-qid Caffeine mg, q3-4h Guaiacol mg, q4h Carbetapentane mg tid-qid mg Dextromethorphan 20 mg, tid 1-30 一 咖啡因 90% adenosine 11 adenosine dnosine (A 1 A 2a ) adenosine Catacholamine mmhg 5-10 mmhg Nurminen 17 6 mg/kg/day ( ) 二 彼此間的交互作用 caffeine dl-methylephedrine chlorphemiramine 5 dl-methylephedrine adrenergic agonist effect QT Pseudoephedrine α- β- adrenergic receptors catecholamine 8 Chlorpheniramine (H1-receptor antagonist) anticholinergic 128 THE JOURNAL OF TAIWAN PHARMACY Vol.28 No.1 Mar

5 (sinus tachycardia) 6,7 肆 結論 ephedrine ephedrine 參考資料 : ; Jana Sawynok: Pharmacological rational for the clinical use of caffeine, Drugs 1995; 49 (1): Mary Anne Koda-Kimble, Lloyd Yee Young: Applied therapeutics: The clinical use of drugs, Lippincott Williams and Wilkins, 7th Edition. USA, Charles F. Lacy: Lexi Comp's Drug Information Handbook. Lexi-Comp Inc. 2007, USA 5. Alex F. Manini, Christophor Kabrhel, Todd W. Thomsen: Acute myocardial infarction after over-the counter use of pseudoephedrine. Annals of emergency medicine 2005; 45(No. 2): Richard H. Schwartz: Adolescent abuse of dextromethorphan. Clinical pediatrics 2005; 44(7): Brent T. Burton, Murray Rice, Les E: Schmertzler: Atriovenricular block following overdose of decongestant cold medication. The journal of emergency medicine 1985; 2: "Acetaminophen, chlorpheniramine, methylephedrine, caffeine, carbetapentane, and Dextromethorphan", in DRUGDEX System. Thomson Reuters (Healthcare) Inc. (accessed December 8th, 2010). 9. Chvasta TE, Cooke AR. Emptying and absorption of caffeine from the human stomach. Gastroenterology 1971; 1: Rall TW, Drugs used in the treatment of asthma: the methylxanthines, cromolyn sodium, and other agents. In: Gilman AG, Rall TW, Nies AS, Taylor P, editors. Goodman and Gilman's the pharmacological Basis of Therapeutics. New York: Pergamon Press; p Dunwiddie TV, Masino SA. The role and regulation of adenosine in the central nervous system. The Annual Review of Neuroscience 2001; 24: Casiglia E, Paleari CD, Petucco S, Bongiovi S, Colangeli G, Baccilieri MS, Pavan L, Pernice M, Pessina AC. Haemodynamic effects of coffee and purified caffeine in normal volenteers: a placebo-controlled clinical study. Journal of Human Hypertension 1992; 6: Pincomb GA, Sung BH, Lovallo WR, Wilson MF. Consistency of cardiovascular response pattern to caffeine across multiple studies using impedance and nuclear cardiograohy. Biological Psychology 1993; 36: Smits P, Thien T, Van't Laar A. Circulatory effects of coffee in relation to the pharmacokinetic of caffeine. The American Journal of Cardiology 1985; 56: Sung BH, Whitsett TL, Lovallo WR, al' Absi M, Pincomb GA, Wilson MF. Prolonged increase in blood pressure by a single oral dose of caffeine in mildly hypertensive men. The American Journal of Hypertension 1994; 7: Hartley TR, Lovallo WR, Whitsett TL. Cardiovascular effects of caffeine in men and womwn. The American Journal of Cardiology 2004; 93: Nurminen ML, Niittynen L, Korpela R, Vapaatalo H. Coffee, caffeine and blood pressure: a critical review. European Journal of Clinical Nutrition 1999 Nov; 53(11): Mar 藥學雜誌第 110 冊 129

6 用藥安全 Drug Safety Cardiac Adverse Reactions Induced by Co-Ingesting Cold Syrup with Energizing Drink A Case Report Ya-Pin Tseng 1, Fen-Ming Huang 2 Department of Pharmacy, Kaohsiung Medical University Hospital 1 Hong-Shin Pharmacy 2 Abstract There are a variety of commercially available cold remedies or cold syrup consumed for self-care purposes. Most of consumers only are aware of the chronic hepatic and renal impairment caused by analgesics contained in those products but ignore the potential risk resulted from other ingredients such as caffeine, or methyl ephedrine which may be misused unintentionally in the way of short-term but excess doses. In the present case, a 63 year-old male came to our ER due to high blood pressure and tachycardia. Treating with antihypertensive agents appeared to have no improvement. Further inquiring of patient s medicinal history found that cold remedies for the common cold and energizing drinks for the sense of tiredness were simultaneously ingested during the past several days. This patient was treated and discharged after four-hour observation. After months in the same year, the patient readmitted to ER with the unstable blood pressure due to ingesting of cold remedies and energizing drinks. Co-ingesting common cold syrup with energizing drinks resulted in caffeine overdose which triggered both ER admissions. 130 THE JOURNAL OF TAIWAN PHARMACY Vol.28 No.1 Mar