氯丙咪嗪致急性肌张力障碍1例报告

患者男,25岁,因失眠精神紧张2年,于1995年5月11日首次住我院,入院后内科及神经系统检查无阳性发现,精神检查:强迫观念,强迫动作,焦虑情绪,自知力完整。诊断为:强迫性神经症,首次接受氯丙咪嗪治疗。入院后首次单用氯丙咪嗪150 mg/d治疗10 d,     

氯丙咪嗪合并西酞普兰治疗强迫症的疗效研究

目的分析比较西酞普兰合并氯丙米嗪与单一氯丙米嗪治疗强迫症的临床疗效。方法回顾分析确诊为强迫症患者58例,随机分为实验组和对照组,每组各29例,实验组给予西酞普兰和氯丙咪嗪,对照给予氯丙咪嗪,疗程同为8周,采用耶鲁布朗强迫量表进行疗效分析。结果实验组的有效率为82.8%,对照组的有效率为65.6%,两组比较差异有统计学意义(P<0.05)。结论西酞普兰联合氯丙咪嗪治疗强迫症,其治疗效果优于单用氯丙咪嗪治疗,值得临床推广使用。     

甘麦大枣汤辅助治疗抑郁症的临床观察

目的观察甘麦大枣汤配合氯丙咪嗪治疗抑郁症的临床疗效。方法选取2007年6月至2010年6月的186例抑郁症患者,随机分成两组,治疗组93例,应用甘麦大枣汤配合氯丙咪嗪治疗,对照组93例,单纯应用氯丙咪嗪治疗,在治疗前后对两组疗效不良反应进行测查。结果两组抑郁情况都均有明显改善,HAMD减分率显著(P<0.01),治疗组组的疗效评价及不良反应发生概率均优于对照组(P<0.05)。结论甘麦大枣汤配合氯丙咪嗪治疗抑郁症非常有效,且会减少不良反应,明显提高药物治疗依从性。     

氯丙咪嗪联合复方玄驹胶囊治疗早泄疗效观察

目的:观察氯丙咪嗪联合复方玄驹胶囊治疗早泄的疗效.方法:405例早泄患者,分为治疗组(205例)和对照组(200例).两组患者均服用氯丙咪嗪,治疗组同时服用复方玄驹胶囊.治疗4周后观察性生活满意度.结果:治疗后治疗组性生活满意度的治愈率和改善率分别为21.9%和56%,均显著优于对照组.结论:氯丙咪嗪联合复方玄驹胶囊治疗早泄有明显疗效.     

氯丙咪嗪口服与口服加静脉滴注治疗抑郁症比较

目的比较单纯口服与口服加静脉滴注氯丙咪嗪治疗抑郁症的疗效。方法选择60例中重度抑郁症患者随机分为两组,分别接受单纯口服氯丙咪嗪和口服加静脉滴注氯丙咪嗪的方法治疗。用汉密顿抑郁量表(HAMD)的减分率评价疗效。结果口服加静脉滴注氯丙咪嗪组HAMD减分率高,且无1例出现自杀行为。结论口服加静滴氯丙咪嗪治疗中重度抑郁症,奏效快、疗效高,出现自杀的风险低。     

氟西汀与氯丙咪嗪治疗强迫症临床观察

目的 :观察氟西汀和氯丙咪嗪治疗强迫症的疗效和不良反应。方法 :对 2 8例强迫症患者分别应用氟西汀或氯丙咪嗪治疗进行对照分析。结果 :氟西汀和氯丙咪嗪疗效相近 ,两者差异无显著性 ,但氟西汀不良反应低于氯丙咪嗪。结论 :氟西汀与氯丙咪嗪对强迫症均有较好疗效 ,但氟西汀有服用剂量小、使用方便、副反应较轻等优点。     

舍曲林与氯丙咪嗪治疗强迫症临床效果分析

目的 探究舍曲林与氯丙咪嗪治疗强迫症的临床效果.方法 选取我院2012年1月-2013年3月治疗的强迫症患者80例,随机分为舍曲林组合氯丙咪嗪组,每组40例,分别使用舍曲林和氯丙咪嗪治疗两组患者,疗程为2个月.评定疗效使用Yale-Brown 强迫量表（Y-Bocs）、汉密尔顿焦虑量表（HAMA）、汉密尔顿抑郁量表（HAMD）,并统计两组患者的有效率、显效率和不良反应率.结果 舍曲林组的总有效率为85.0%,高于氯丙咪嗪组的80.0%,差异无统计学意义（P＞0.05）.舍曲林组患者不良反应16例（40.0%）,氯丙咪嗪组不良反应30例（75.0%）,两组比较差异有统计学意义（P＜0.05）.舍曲林组Y-Bocs、HAMD、HAMA评分均低于氯丙咪嗪组,差异有统计学意义（P＜0.05）.结论 舍曲林和氯丙咪嗪相比,治疗强迫症的疗效相当,但舍曲林比氯丙咪嗪不良反应率更低,具有更高的安全性,值得临床推广.     

氯丙咪嗪合并阿立哌唑治疗强迫症13例体会

目的探讨氯丙咪嗪合并阿立哌唑治疗强迫症的疗效。方法氯丙咪嗪合并阿立哌唑治疗强迫症13例疗效研究。结果氯丙咪嗪和阿立哌唑合并后治愈率15.4%,明显好转率46.2%,有所改善率30.8%,无改善率0.08%。结论氯丙咪嗪合并阿立哌唑治疗强迫症,提高了有效治疗率,不良反应未见增加。     

84例强迫症患者临床治疗对比分析

目的比较氟西汀与氯丙咪嗪治疗强迫症的疗效和不良反应。方法对84例符合CCDM-2-R诊断标准的强迫症患者随机分为两组,分别用氟西汀和氯丙咪嗪治疗8周,采用Y-BOCS、HAMD）和TESS评定疗效和不良反应。结果氟西汀与氯丙咪嗪疗效相似,两组显效率和有效率差异无显著性,但氟西汀不良反应的发生率明显低于氯丙咪嗪。结论氟西汀治疗强迫症的疗效与氯丙咪嗪相当,但不良反应轻微,耐受性良好。     

氯丙咪嗪治疗强迫性神经症37例临床分析

37例强迫症患者用氯丙咪嗪治疗,按疗效作了随机对照研究。氯丙咪嗪剂量为20-80mg/d,疗程为1mo(月)。结果:有效率76％,对照组用阿米替林有效率为56％。两者在统计学上无明显差异。本文结果提示,氯米咪嗪与阿米替林相比,在治疗强迫症方面疗效无差异。然而,对顽固的强迫行为疗效均欠佳。在强迫症无更有效的药物治疗前,氯丙咪嗪仍是可供选择的药物。     

Hepatotoxicity and surface activity of tricyclic antidepressants in vitro.

Cytotoxicity to isolated rat hepatocytes of the tricyclic antidepressants, chlorimipramine, nortriptyline, amitriptyline, imipramine, and of doxepin was determined by the leakage of cytoplasmic and lysosomal enzymes into surrounding media. The rank order of toxicity was: chlorimipramine > nortriptyline > amitriptyline > imipramine > doxepin. All tricyclic antidepressants tested lowered the surface tension of the salt solution contained in the tissue culture media. The rank order of surface activity was the same as that of hepatotoxicity in vitro. These results suggest that the differences in membrane damage produced by tricyclic antidepressants may be related to surface activity which in turn may determine the extent of adsorption onto cell membranes.     

盐酸多塞平乳膏人体透皮吸收试验

目的 :比较进口与国产5 %盐酸多塞平乳膏的人体透皮吸收效果。方法 :采用高效液相色谱法测定血药浓度 ,8位健康男性受试者按交叉试验设计 ,以进口的5 %盐酸多塞平乳膏为对照品 ,对比研究国产5 %盐酸多塞平乳膏的人体透皮吸收效果。结果 :连续8d于受试者前臂皮肤涂抹相同剂量的盐酸多塞平乳膏试验品和对照品后进行测定 ,两组血药浓度均较低 ,无显著性差异。结论 :国产5 %盐酸多塞平乳膏的人体透皮吸收效果可达国外同类品种水平 ,且安全、有效     

Tricyclic antidepressive drugs and dopamine-sensitive adenylate cyclase from rat brain striamtum

Tricyclic antidepressant drugs were examined as inhibitors of dopamine-sensitive adenylate cyclase in a cell-free homogenate of rat brain striatum. Amitriptyline (K_i 0.17 μM) and doxepin (K_i 0.24 μM) were found to be potent inhibitors of dopamine-sensitive adenylate cyclase, chlorimipramine (K_i 0.59 μM) and nortriptyline (K_i 0.50 μM) were moderate inhibitors and imipramine, desmethylimipramine, protriptyline melitracene were weak inhibitors with K_i values higher than 1 μM.     

Effects of norepinephrine and serotonin uptake inhibitors on the schedule-controlled behavior of the pigeon

The effects of nortriptyline, amitriptyline, desipramine, chlorimipramine, protriptyline, doxepin, nisoxetine, fluoxetine and iprindole were determined on responding by pigeons under a multiple fixed-ratio 30-response, fixed-interval 10-minute schedule of grain presentation. Those drugs which have been shown to block uptake of norepinephrine decreased fixed-interval quarter-life values. Those which are considered most selective as norepinephrine uptake inhibitors also increased overall fixed-interval responding. These increases in fixed-interval responding, both on local and overall rates, in pigeons appear to be due to the actions of these drugs to inhibit uptake of norepinephrine rather than to other actions.     

Comparative animal studies on cardiovascular toxicity of tri- and tetracyclic antidepressants and citalopram; relation to drug plasma levels

The aim of the present study was to compare cardiovascular and/or cardiotoxic effects of eight anti-depressants (imipramine, chlorimipramine, amitriptyline, nortriptyline, doxepin, maprotiline, mianserin and citalopram) in anaesthetized cats after oral dosing and in conscious rabbits after intravenous infusion. In the cats drug plasma levels were determined as well. When estimated from ECG recordings, citalopram and chlorimipramine in particular, but also mianserin, appeared less cardiotoxic than the other drugs tested. The cardiovascular effects seen in the cats were with few exceptions identical for all the drugs tested but not seen at the same dose (concentration). Safety margins were defined as minimal doses or plasma levels when ECG changes (conduction or rhythm) or cardiovascular effects (±10% change of initial value in a series of parameters) occurred in experimental animals divided by maximal therapeutic dose or mean plasma levels in patients. From comparisons of the safety margins it is concluded that except for citalopram and mianserin (safety margins 80 and 18 respectively in cats and >15 in rabbits) all the other drugs tested (safety margins 9) have a cardiotoxic potential. The probability that cardiovascular side effects may occur is less pronounced for citalopram (safety margins 10–32) than for all the other drugs tested (safety margins ranging from 0.1 to <5).     

Clomipramine. An overview of its pharmacological properties and a review of its therapeutic use in obsessive compulsive disorder and panic disorder

During the 20 years that have elapsed since clomipramine (chlorimipramine) was first marketed, it has become well established in the treatment of depressive illness, particularly treatment-resistant depression. However, in addition to its role as an antidepressant, attention is being focused on the use of clomipramine in 2 other areas of psychiatry: obsessive compulsive disorder and panic disorder. Short term clinical trials have shown that clomipramine is generally more effective than amitriptyline, imipramine, desipramine, nortriptyline or clorgiline in reducing obsessive compulsive symptoms. Clomipramine appears to produce some short term benefit with exposure therapy in patients with obsessive compulsive disorder. However, the efficacy of the drug after long term follow-up has not been fully investigated. The antiobsessional efficacy of clomipramine appears to be independent of its antidepressant activity. In patients with panic disorder with or without agoraphobia (DSM-IIIR), clomipramine reduces the frequency and severity of panic attacks within 7 to 21 days of beginning treatment and efficacy is maintained for at least 12 months. Clomipramine is more effective than imipramine, the generally accepted standard treatment for patients with panic disorder after 2 weeks' treatment, but after 6 or 10 weeks both drugs are similarly effective. Other double-blind studies have shown that clomipramine is more effective than placebo and at least as effective as fluvoxamine and oxitriptan (5-hydroxytryptophan) in reducing panic attacks and associated anxiety. Adverse effects associated with clomipramine treatment are mild to moderate in nature and are predominantly a result of the drug's anticholinergic activity. The incidence of seizures is dose related, occurring in 0.48% of all patients receiving clomipramine less than or equal to 250 mg/day and 2.1% of patients receiving greater than or equal to 300 mg/day. In conclusion, the available data indicate that clomipramine is a worthwhile addition to the limited treatments available for obsessive compulsive disorder and panic disorder, two psychiatric disorders which have previously been difficult to manage pharmacologically.     

Some effects of chlorimipramine and imipramine on the schedule-controlled behavior of the pigeon

The effects of imipramine and chlorimipramine on schedule-controlled behavior were compared by examining the effects of both drugs on the performance of pigeons under a multiple fixed-interval 600-s fixed-ratio 30-response (mult FI 600 FR 30) schedule of grain presentation and under a mult FI 200 FI 200 schedule in which responding in one component was punished. Imipramine decreased the rate of FR 30 responding at slightly lower doses than or the same doses as those needed to decrease the rate of FI 600 responding. In contrast, chlorimipramine decreased the rate of FI 600 responding at lower doses than those needed to decrease the rate of FR responding. These effects of chlorimipramine were similar to those of chlorpormazine subsequently determined in the same pigeons. Imipramine and chlorimipramine increased proportionally more or decreased proportionally less the lower rates of responding during the first half of the FI 600 than the higher rates of responding during the second half. When the effects of imipramine or chlorimipramine on performance under the mult FI 200 FI 200 schedule were determined, both imipramine and chlorimipramine affected the rates of punished responding and unpunished responding similarly. Thus, while some effects of chlorimipramine on the schedule-controlled behavior of the pigeon are similar to the effects of imipramine, other effects of chlorimipramine more strongly resemble those of chlorpromazine in the pigeon.     

Interaction studies between three antidepressant drugs (chlorimipramine, imipramine and zimelidine) and noradrenaline, tyramine and vagal stimulation on the heart rate and blood pressure in dogs

Anaesthetized Beagle dogs were given increasing intravenous doses of imipramine, chlorimipramine or zimelidine. At each dose interval the interference of the drug administered with the effects on blood pressure and heart rate of vagal stimulation, NA injection and tyramine injection was investigated. Also, the in vitro uptake of 5-HT into platelets after in vivo administration to unanaesthetized dogs of 5 mg chlorimipramine or 5 mg zimelidine was studied. Chlorimipramine and zimelidine were found to be about equipotent as regards 5 HT-uptake into platelets after in vivo administration. Imipramine and chlorimipramine potentiated the effects of NA after the 2 mg/kg dose. Imipramine but not chlorimipramine interfered with the effects of tyramine after the 4 mg/kg dose. Zimelidine did not interfere with either NA or tyramine at any dose level studied (maximal cumulative dose 62 mg/kg). The effect of vagal stimulation was significantly inhibited after 8 mg/kg (cumulative dose 14 mg/kg) of imipramine and 16 mg/kg (cumulative dose 30 mg/kg) of chlorimipramine and zimelidine, respectively. It is concluded that zimelidine in comparison with imipramine and chlorimipramine has no or at most a slight effect on peripheral adrenergic neurones. It has less pronounced anticholinergic properties than imipramine but is about equipotent to chlorimipramine in this respect.     

Topical application of doxepin hydrochloride, capsaicin and a combination of both produces analgesia in chronic human neuropathic pain: a randomized, double-blind, placebo-controlled study

AIMS: To assess the analgesic efficacy of topical administration of 3.3% doxepin hydrochloride, 0.025% capsaicin and a combination of 3. 3% doxepin and 0.025% capsaicin in human chronic neuropathic pain. METHODS: A randomized, double-blind, placebo-controlled study of 200 consenting adult patients. Patients applied placebo, doxepin, capsaicin or doxepin/capsaicin cream daily for 4 weeks. Patients recorded on a daily basis overall pain, shooting, burning, paraesthesia and numbness using a 0-10 visual analogue scale during the week prior to cream application (baseline levels) and for the 4 week study period. Side-effects and desire to continue treatment were also recorded. RESULTS: Overall pain was significantly reduced by doxepin, capsaicin and doxepin/capsaicin to a similar extent. The analgesia with doxepin/capsaicin was of more rapid onset. Capsaicin significantly reduced sensitivity and shooting pain. Burning pain was increased by doxepin and by capsaicin and to a lesser extent by doxepin/capsaicin. Side-effects were minor. One patient requested to continue placebo cream, 17 doxepin cream, 13 capsaicin and 9 the combination of doxepin and capsaicin. CONCLUSIONS: Topical application of 3.3% doxepin, 0.025% capsaicin and 3.3% doxepin/0. 025% capsaicin produces analgesia of similar magnitude. The combination produces more rapid analgesia.     

博乐欣缓释片与氯丙咪嗪治疗抑郁症的临床疗效和安全性比较

目的探讨博乐欣缓释片治疗抑郁症的临床疗效和安全性。方法对符合CCMD-3抑郁症发作诊断标准的74例抑郁症患者进行博乐欣缓释片和氯丙咪嗪的对照研究,其中博乐欣缓释片组34例,氯丙咪嗪组40例。于治疗前及治疗后1、2、4、6周末采用汉密顿抑郁量表（HAMD）,副反应量表（TESS）评定。采用HPLC测定治疗后的第2、6周末博乐欣缓释片血浓度。结果经6周治疗后,博乐欣缓释片组治疗显效率为82％,氯丙咪嗪组为75％,两组相比较,差异无显著性（P〉0．05）;第1周末两组的HAMD减分率比较差异有高度显著性（P〈0．01）;博乐欣缓释片组显效时间为（5．68±3．55）d,氯丙咪嗪组为（12．74±5．63）d。结论博乐欣缓释片治疗抑郁症的疗效与氯丙咪嗪相当,但前者起效更快,副反应少,依从性好,安全性高。适合临床快速控制抑郁症状。