市販の鼻炎薬（持続性プレコール鼻炎薬®）の倍量内服によって著明な血圧上昇と心電図変化が引き起こされた1例

An Electrocardiographic Clnange and Severe Hypertension Caused by Excessive Doses of Rhinitis Medicilne : A case report

　症例は23歳の女性．高プロラクチン血症による無月経のため連日bromocriptine 1.25mgを服用していた．1カプセルにPhenylpropanolamine（以下PPA）を45mg含有する市販鼻炎薬を誤って2カプセル服用した後，頭痛，悪心，動悸，息切れが出現し，血圧上昇（170/110mmHg）と心電図変化（ST低下とT波逆転）が認められた．PPAは交感神経作動薬であり，高血圧，不整脈，心筋梗塞などの副作用が報告されている．本例では，2カプセル中で90mgの過量のPPAが，持続性ドパミン作動薬であるbromocriptineとの相互作用によって著明な血圧上昇を起こしたものと思われた．PPAは市販薬剤に広く含有されており，心電図変化を伴うような強い副作用をもたらしえることも認識しておかねばならない．

A 23-year-old female had been taking 1.25 mg of bromocriptine every day for amenorrhea caused by hyperprolactinemia. To treat rhinitis, she took, by mistake, a double close of a rhinitis medicine, which contains 45 mg -LTA per capsule. Only one capsule should be taken every 12 hours. Two hours later, she suffered an intense headache, nausea and palpitation and her blood pressure was 170/110mmHg. The initial electrocardiogram showed ST segment depressions and inverted T-waves. Forty minutes later she improved and a subsequent electrocardiogram showed inverted T-waves. Two days later. she remained asymptomatic and her electrocardiogram returned to normal. Hematological values and blood chemistry findings were all within normal limits, while the endocrine function test and drug lymphocyte stimulating test for this medicine produced negative responses. PPA is a sympathomimetic agent and serious adverse reactions to it, including hypertension, stroke and arrhythmia have been reported. Bromocriptine is a dopaminergic agent, and it has been pointed out that the drug interaction between PPA and an adrenergic agonist might cause marked hypertension. In our case, the symptoms experienced by our patient could easily be traced to the adverse reactions to the 90mg of PPA. It should be kept in mind that electrocardiographic changes may occur if excessive dose of PPA is administered.