苯海拉明氯氮平所致流涎

目的：研究苯海拉明对氯氮平所致流涎副作用的疗效。方法 ：女性５０例，服氯氮平治疗后，均出现流涎副作用，每晚口服苯海拉明５０ｍｇ治疗，１０ｄ为一个疗程。结果：苯海拉明治疗氯氮平所致流涎的有效率达１００％，起效快，无其他副作用。结论：苯海拉明能有效治疗氯氮平所致流涎症状。     

不同剂量苯海拉明治疗氯氮平引起的流涎

目的：评价不同剂量苯海拉明对氯氮平引起流涎的疗效及不良反应。方法：服用氯氮平的精神分裂症病人９０例，分为３组，每组３０例。苯海拉明５０ｍｇ／ｄ组给予苯海拉明５０ｍｇ，ｐｏ，ｑｄ×２ｗｋ。苯海拉明２５ｍｇ／ｄ组给予苯海拉明２５ｍｇ，ｐｏ，ｑｄ×２ｗｋ。对照组不增服其他药物，仅作临床观察。结果：治疗组临床总有效率与对照组比较，苯海拉明５０ｍｇ／ｄ组为９３％（Ｐ＜０．０１）；苯海拉明２５ｍｇ／ｄ组为７７％（Ｐ＜０．０１）；苯海拉明２组间疗效无显著差异（Ｐ＞０．０５）；不良反应少而轻微。结论：苯海拉明治疗氯氮平引起的流涎疗效显著且安全。     

西咪替丁治疗氯氮平所致流涎

目的：观察西咪替丁治疗氯氮平所致流涎的疗效。方法：选择住院精神病人单一服用氯氮平致严重流涎５０例（均为男性，年龄２９±ｓ１３ａ）。用西咪替丁口服，流涎按修正Ｓａｍｐｓｏｌ量表评分为２分者按０．４ｇ／ｄ，中午、晚上各服０．２ｇ；３分者按０．６ｇ／ｄ，中午服０．２ｇ，晚上服０．４ｇ；４分者按０．８ｇ／ｄ，早上、中午各服０．２ｇ，晚上０．４ｇ。１个疗程为４ｗｋ。结果：痊愈２６例（占５２％），总有效率９２％。无明显副作用。结论：西咪替丁治疗氯氮平所致流涎疗效满意。     

西咪替丁治疗氯氮平所致流涎

目的；观察西咪替丁治疗氯氮平所致流涎的疗效。方法：选择住院精神病人单一服用氯氮平致严重流涎５０例（均为男性，年龄２９±ｓ１３ａ）。用西咪替丁口服，流涎按修正Ｓａｍｐｓｏｌ量表评分为２分按０．４ｇ／ｄ，中午，晚上各服０．２ｇ；３分按０．６ｇ／ｄ，中午服０．２ｇ，晚上服０．４ｇ；４分按０．８ｇ／ｄ，早是，中午各服０．２ｇ，晚上０．４ｇ。１个疗程为４ｗｋ结果：痊愈２６例（占５２％）总有效率９２％。     

不同济量苯海拉明治疗氯氮平引起的流涎

目的：评价不同剂量苯海拉明对氯氮平引起流涎的疗效及良反应。方法：服用氯氮平的精神分裂症病人９０例，分为３组，每组３０例。结论：苯海拉明治疗氯氮平引起的流涎疗效显著且安全。     

苯海拉明与多虑平治疗氯氮平所致流涎的对照观察

目的 比较苯海拉明和多虑平治疗氯氮平引起的流涎的疗效。方法 随机将病人分为两组,分别使用苯海拉明(50～150mg／d),多虑平(50～150mg／d)。结果 两药治疗氯氮平所致的流涎有效率均为92%,且未见不良反应。结论 苯海拉明治疗氯氮平所致的流涎疗效与多虑平相似。     

阿司咪唑治疗氯氮平的流涎副作用60例

用阿司咪唑治疗氯氮平的流涎副作用６０例（男性４７例，女性１３例；年龄３１±ｓ１０ａ），剂量１０ｍｇ，ｐｏ，ｑｎ，２ｗｋ为一个疗程。结果显效率７２％，有效率９２％。整个治疗过程中未发现与阿司咪唑相关的不良反应。     

氟康唑治疗老年人念珠菌病

目的：对氟康唑治疗４６例老年人（肺、口腔、泌尿道等）念珠菌病的疗效和毒副作用进行分析，探讨其临床治疗价值。方法：老年人念珠菌病的例（男性４２例，女性４例；年龄６９±ｓ４ａ），２６例ｄ１，４０ｍｇ，ｐｏ，ｄ２起改为２００ｍｇ，ｐｏ，ｑｄ。另２０例ｄ１４００ｍｇ，静脉滴注（静滴），ｄ２起改为２００ｍｇ静滴，ｑｄ，７－１４ｄ后改为２００ｍｇ，ｐｏ，ｑｄ。２组均以４ｗｋ为一个疗程，结果：治愈率９３％。其副作用轻，９例有一过性胃肠道反应。结论：氟康唑治疗老年人念珠菌感染疗效好，副作用轻，是治疗深部真菌感染较为满意的药物。     

溴丙胺太林与多塞平治疗氯氮平所致流涎的对照分析

目的：探讨溴丙胺太林与多塞平治疗氯氮平所致流涎的疗效和不良反应。方法：将符合CCMD-3精神分裂症诊断标准的120例患者,随机分成2组,单服氯氮平后出现流涎不良反应,分别给溴丙胺太林与多塞平治疗。结果：两组有效率均为95％,且溴丙胺太林组不良反应少。结论：小剂量溴丙胺太林治疗氯氮平所致流涎安全有效、无明显不良反应,值得临床推广。     

尼莫地平预防蛛网膜下腔出血的脑血管痉挛

目的：观察尼莫地平预防蛛网膜下腔出血（ＳＡＨ）后的脑血管痉挛（ＣＶＳ）。方法：ＳＡＨ病人１０７例，男性５５例，女性５２例，年龄５４±ｓ９ａ，随机分尼莫地平组（６７例）与对照组（４０例）。尼莫地平组中２９例于ｄ１～２用静脉滴注（静滴）２ｍｇ／ｄ，ｄ３起４ｍｇ／ｄ，７～１４ｄ以后口服尼莫地平３０ｍｇ／６ｈ，另３８例于ｄ１～１４用尼莫地平２ｍｇ／ｄ静滴，余同上，共４ｗｋ．对照组用一般的综合治疗４ｗｋ．结果：尼莫地平组死亡率为１５％，症状性ＣＶＳ发生率为３％，分别低于对照组３２％与２２％（Ｐ＜０．０５与Ｐ＜０．０１）。未发现副作用。结论：尼莫地平预防ＳＡＨ后的ＣＶＳ有效。     

Effects of H1 antagonists on cholinomimetic-induced tremulous jaw movements: studies of diphenhydramine, doxepin, and mepyramine

In several previous studies, tremulous jaw movements in rats have been used to assess the effects of antiparkinsonian drugs and atypical antipsychotics. Because antihistamines such as diphenhydramine are used as antiparkinsonian agents, and atypical antipsychotic drugs such as clozapine and olanzapine have high affinity for histamine H1 receptors, the present study investigated the effects of H1 antagonists on cholinomimetic-induced jaw movements. Diphenhydramine, doxepin, and mepyramine (all injected IP 2.5-20.0 mg/kg) were assessed for their ability to block the jaw movements induced by 5.0 mg/kg of the anticholinesterase tacrine. Within this dose range, only diphenhydramine produced a robust and significant reduction in jaw movement activity. Thus, diphenhydramine was subjected to further testing, which employed procedures previously used to assess the effects of other antitremorogenic drugs, such as clozapine. Diphenhydramine did not induce jaw movement activity. In addition to suppressing jaw movement activity after acute injections, diphenhydramine also suppressed tacrine-induced jaw movements after repeated (14-day) administration. In summary, the present results show that diphenhydramine suppresses cholinomimetic-induced jaw movements, an effect that is similar to other antiparkinsonian or antitremor drugs such as anticholinergics, L-DOPA, DA antagonists, and clozapine. Nevertheless, doxepin produced only mild effects, and mepyramine, which has a higher affinity and selectivity than diphenhydramine for H1 receptors, failed to suppress cholinomimetic-induced jaw movements. These results suggest that diphenhydramine suppresses tremulous movements through a mechanism that does not depend upon antagonism of histamine H1 receptors.     

国产喹硫平与氯氮平治疗精神分裂症的疗效比较

目的 :探讨喹硫平治疗精神分裂症的疗效及不良反应。方法 :6 0例精神分裂症病人分为 2组 ,喹硫平组 30例 ,男性 19例 ,女性 11例 ,年龄 (37±s8)a ,给予喹硫平 ,氯氮平组 30例 ,男性 2 0例 ,女性10例 ,年龄 (36± 8)a ,给予氯氮平 ,2组开始剂量约为 5 0mg·d- 1,以后视病情调整 ,分别为 (42 3± 2 0 )mg·d- 1和 (415± 18)mg·d- 1,分 2次口服 ,共治疗 6wk ,采用阳性症状与阴性症状量表 (PANSS)评定临床疗效 ,同时用不良反应症状量表 (TESS)评定不良反应。结果 :喹硫平组的有效率达 87% ,与氯氮平组 (6 0 % )比较无显著差异 (P >0 .0 5 )。喹硫平组的不良反应中活动减少、视物模糊、便秘、流涎、头晕、体重增加的发生率显著少于氯氮平组 (P <0 .0 1或P <0 .0 5 )。结论 :国产喹硫平治疗精神分裂症的疗效是肯定的 ,与氯氮平相似 ,不良反应轻、少 ,是一种安全、有效的抗精神病药     

Is clonidine useful for treatment of clozapine-induced sialorrhea?

Clozapine has shown superior efficacy in treatment of refractory schizophrenia, but its use is limited by emergent side-effects. Among other adverse effects, sialorrhea is a troublesome side-effect, its stigmatizing nature results in poor treatment compliance. Several hypotheses have been put forward in the etiology of clozapine-induced sialorrhea. 2 adrenergic antagonism is hypothesized to be involved in its pathophysiology, based on the response to clonidine and lofexidine. Oral clonidine (50 to 100 g/day) was tried on 12 stable outpatients of schizophrenia maintained on clozapine. Wet area over the pillow as reported by the patients was recorded at baseline and at 4 weeks of treatment along with the subjective response after the treatment. Most of the patients reported a decrease in sialorrhea without any adverse events. We describe encouraging results in an open case series of oral clonidine for clozapine-induced sialorrhea.     

Determination of diphenhydramine in rat milk and plasma and its effects on milk composition and mammary gland nucleic acids

To study the excretion of diphenhydramine into rat milk, milk and plasma concentrations of diphenhydramine were determined in lactating rats after single or multiple oral doses. Four hours after a single dose of 40 or 100 mg/kg of diphenhydramine, milk concentrations of the drug averaged 0.30 and 2.2 micrograms/mL, respectively, in two experiments, and the milk:plasma ratios ranged from 4.4 to 7.5. Multiple doses did not significantly affect the plasma or milk concentrations or the milk:plasma ratios, which were similar to the theoretical milk:plasma ratio based on pH partitioning for this compound (i.e., 4.0). Although the concentration of diphenhydramine was higher in milk than in plasma, the estimated dose received by the pups (0.057 mg/kg/d) based on the milk concentrations was much lower than that given to the mother. Oral diphenhydramine treatment at doses which significantly reduced maternal food consumption had no effect on milk solid, lipid, protein, or lactose concentrations, nor on mammary gland RNA or DNA content, indicating that diphenhydramine did not adversely affect lactation.     

Botulinum toxin as an effective treatment of clozapine-induced hypersalivation

Hypersalivation is a common and frequently disabling side effect of atypical neuroleptics such as clozapine. Current treatment options of this adverse advent are limited by lack of efficacy or additional side effects. Botulinum toxin (BTX) injections into the parotid glands have been shown to be very effective in treating sialorrhea in the context of various neurological disorders, such as Parkinsons and motor neuron disease. Surprisingly, BTX treatment of drug-induced sialorrhea has not yet been described. We here report a patient with clozapine-induced hypersalivation and a good response to BTX injections lasting for more than 12 weeks, resulting in a marked reduction of the hypersalivation and consequently of his social withdrawal. Our patient serves to alert clinicians to the frequent problem of drug-induced sialorrhea and suggests that BTX injections should be considered as an effective and safe treatment for hypersalivation in psychiatric patients treated with clozapine.The first two authors contributed equally to this work.     

利培酮与氯氮平治疗精神分裂症比较

目的 :比较利培酮和氯氮平治疗精神分裂症的疗效和安全性。方法 :利培酮组 30例 (男性 12例 ,女性 18例 ,年龄 34a±s 10a ,BPRS评分 5 4分± 5分 )用利培酮 1～ 8mg/d ,po ,bid ;氯氮平组 30例 (男性 14例 ,女性 16例 ,年龄 33a± 11a ,BPRS评分 5 5分± 5分 )用氯氮平 5 0～ 40 0mg/d ,po ,bid ;均以BPRS ,TESS评定观察 8wk。结果 :利培酮组有效率为 83% ,氯氮平组为 80 % (P >0 .0 5 )。利培酮组对阴性症状起效较早 ,对兴奋躁动控制较差。利培酮组较多见副作用为锥体外系症状 ( 2 7% ) ,与氯氮平组 ( 3% )比较差异有显著意义 (P <0 .0 5 ) ,其他副作用较少而轻。结论 :利培酮与氯氮平疗效相似 ,适宜剂量 (≤ 4mg/d)的利培酮是一种安全有效的抗精神病药。     

Reversal of clozapine effects on working memory in rats with fimbria-fornix lesions.

Clozapine is an effective antipsychotic drug, but its effects on cognitive function are unclear. Previously, we found that clozapine caused a working memory deficit, which was reversed by nicotine. Hippocampal systems are important in determining clozapine effect on memory. In the current study, the memory effects of clozapine and nicotine administration were determined in rats with lesions of the fimbria-fornix, a fiber bundle which carries cholinergic and other projections between the septum and the hippocampus. Female Sprague-Dawley rats were trained on a win-shift procedure in the radial-arm maze, in which each arm entry was rewarded once per session. Then, 13 rats received bilateral knife-cut lesions of the fimbria-fornix, while 14 rats underwent sham surgery. The rats were tested after subcutaneous injections with combinations of clozapine (0 and 1.25 mg/kg) and nicotine (0, 0.2, and 0.4 mg/kg). In sham-operated rats, clozapine caused a significant (P<0.005) working memory impairment. Fimbria-fornix lesions also caused a significant (P<0.05) memory impairment. Interestingly, clozapine had the opposite effect on working memory in the lesioned vs sham-operated rats. In contrast to its effects in controls, clozapine (1.25 mg/kg) significantly (P<0.05) attenuated the working memory deficit caused by fimbria-fornix lesions. Nicotine (0.2 mg/kg) did not quite significantly improve memory in lesioned rats. The effects of clozapine and nicotine were not additive in the lesioned rats. This study demonstrates the efficacy of clozapine in improving working memory in fimbria-fornix-lesioned rats, whereas it causes impairments in intact rats. Therapeutic treatment with clozapine in people with malfunctions of the hippocampus such as seen in schizophrenia may improve cognitive performance, whereas the same doses of clozapine may impair memory in individuals without hippocampal malfunction.     

甲氧氯普胺联合苯海拉明预防化疗所致呕吐

目的:观察甲氧氯普胺联合苯海拉明的止吐效果.方法:80例癌症化疗的患者,随机分为两组,即治疗组42例和对照组38例.治疗组于化疗前30 min给予口服25 mg苯海拉明,于化疗开始后2 h静脉推注甲氧氯普胺20 mg,以后每4 h推注20 mg,至化疗结束;对照组采用0.9%氯化钠溶液20mL加昂丹司琼8 mg于化疗前30 min静脉推注,隔日再静脉推注8 mg至化疗结束.比较两组疗效.结果:治疗组呕吐的控制有效率为86.4%,对照组呕吐的控制有效率为86.2%,两组比较差异无显著性(P＞0.05).结论:甲氧氯普胺联合苯海拉明的止吐效果与昂丹司琼相同.