内容紹介
Effectiveness of Mirtazapine for Digestive Symptoms in Palliative Care―Retrospective Study of 50 Cases
Summary
Background: Previous research has reported that mirtazapine, a 5-HT3 antagonist, is effective for alleviation of digestive symptoms. Purpose: To elucidate the effect of low-dose mirtazapine on digestive symptoms. Patients and methods: Mirtazapine was administered to 50 cancer patients with digestive symptoms in palliative care, and the data were retrospectively examined. The initial doses ranged from 1.875 to 7.5 mg, and were increased to a maintenance dose according to its effects and the degree of somnolence. Results: The cases were divided into 2 groups based on the cause of the digestive symptoms, including unknown causes(27 cases)and chemotherapy and/or opioid treatment(23 cases). At the initial dose, the efficacy rate was 74.4%, and the effectiveness was significantly higher in patients whose symptoms were due to chemotherapy and/or opioid use than in those with symptoms of unknown cause(p=0.008). The rate of somnolence was 29.5%. Discontinuation of treatment within 1 week occurred in 10 cases. In 40 cases that continued administration of the maintenance dose, the efficacy rate was 82.5%, and the increased doses provided relief in the patient group with digestive symptoms of unknown cause. Conclusions: Low-dose mirtazapine showed different effects depending on the cause of digestive symptoms; therefore, the dose should be increased in patients whose symptoms are of unknown cause. Somnolence often appeared even at a low-dose, and this should be taken into consideration in the palliative care setting.
要旨
背景: 5-HT3受容体拮抗作用をもつミルタザピンは消化器症状に有効とされる。目的: 消化器症状への低用量ミルタザピンの効果を明らかにすること。対象と方法: 消化器症状をもつ緩和ケア領域の癌患者50例を後ろ向きに検討した。初回投与は1/8量(1.875 mg)～1/2量(7.5 mg)で開始し,効果と副作用の眠気に応じ漸増した。結果: 消化器症状の原因により原因不明群(n=27)と化学療法・オピオイド群(n=23)に分かれた。初期低用量では,消化器症状への有効率は74.4%,原因別では化学療法・オピオイド群は原因不明群に比べ有意に効果が高かった(p=0.008)。投与翌日の眠気は29.5%にみられた。1週間以内の中止は10例で,残り40例における維持投与量では有効率は82.5%で,増量により原因不明群でも効果が得られた。結語: 低用量ミルタザピンは消化器症状の原因により効果が異なり,原因不明群では増量が望ましい。副作用では低用量でも投与翌日に眠気がみられ,注意が必要である。
目次
Summary
Background: Previous research has reported that mirtazapine, a 5-HT3 antagonist, is effective for alleviation of digestive symptoms. Purpose: To elucidate the effect of low-dose mirtazapine on digestive symptoms. Patients and methods: Mirtazapine was administered to 50 cancer patients with digestive symptoms in palliative care, and the data were retrospectively examined. The initial doses ranged from 1.875 to 7.5 mg, and were increased to a maintenance dose according to its effects and the degree of somnolence. Results: The cases were divided into 2 groups based on the cause of the digestive symptoms, including unknown causes(27 cases)and chemotherapy and/or opioid treatment(23 cases). At the initial dose, the efficacy rate was 74.4%, and the effectiveness was significantly higher in patients whose symptoms were due to chemotherapy and/or opioid use than in those with symptoms of unknown cause(p=0.008). The rate of somnolence was 29.5%. Discontinuation of treatment within 1 week occurred in 10 cases. In 40 cases that continued administration of the maintenance dose, the efficacy rate was 82.5%, and the increased doses provided relief in the patient group with digestive symptoms of unknown cause. Conclusions: Low-dose mirtazapine showed different effects depending on the cause of digestive symptoms; therefore, the dose should be increased in patients whose symptoms are of unknown cause. Somnolence often appeared even at a low-dose, and this should be taken into consideration in the palliative care setting.
要旨
背景: 5-HT3受容体拮抗作用をもつミルタザピンは消化器症状に有効とされる。目的: 消化器症状への低用量ミルタザピンの効果を明らかにすること。対象と方法: 消化器症状をもつ緩和ケア領域の癌患者50例を後ろ向きに検討した。初回投与は1/8量(1.875 mg)～1/2量(7.5 mg)で開始し,効果と副作用の眠気に応じ漸増した。結果: 消化器症状の原因により原因不明群(n=27)と化学療法・オピオイド群(n=23)に分かれた。初期低用量では,消化器症状への有効率は74.4%,原因別では化学療法・オピオイド群は原因不明群に比べ有意に効果が高かった(p=0.008)。投与翌日の眠気は29.5%にみられた。1週間以内の中止は10例で,残り40例における維持投与量では有効率は82.5%で,増量により原因不明群でも効果が得られた。結語: 低用量ミルタザピンは消化器症状の原因により効果が異なり,原因不明群では増量が望ましい。副作用では低用量でも投与翌日に眠気がみられ,注意が必要である。