去甲哌替啶
化合物
去甲哌替啶是一種4-苯基哌啶的衍生物，化學式為C14H19NO2。它是哌替啶的前體及有毒代謝物。它被列入聯合國麻醉品單一公約，也被美國列入到受管制物質法案附表II，2014年的生產限額為11克（0.39盎司）。[1]
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| 臨床資料 | |
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| 給藥途徑 | N/A |
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| 法律規範狀態 | |
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| 識別資訊 | |
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| CAS號 | 77-17-8  |
| PubChem CID | |
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| CompTox Dashboard (EPA) | |
| ECHA InfoCard | 100.000.918 |
| 化學資訊 | |
| 化學式 | C14H19NO2 |
| 摩爾質量 | 233.31 g·mol−1 |
| 3D模型（JSmol） | |
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去甲哌替啶因可用於合成哌替啶及相關的N-取代衍生物（如依託利定[2]、苄替啶[3]、呋替啶[4]）而受到管制。不過，去甲哌替啶本身的類阿片作用低，是一種引起抽搐的興奮劑。[5][6]
當把哌替啶用作鎮痛藥時，就要大劑量使用[7]或靜脈注射哌替啶。[8]這會去甲哌替啶產生的速率比排泄去甲哌替啶的速率快，導致去甲哌替啶累積產生的併發症，包括抽搐、肌陣攣[9]、低血鈉症。[10]這些併發症可能會很嚴重，甚至可能導致死亡。[11]這些併發症在老年人[12]及肝功能或腎功能受損的人[13]身上更明顯。
哌替啶在體內會被肝臟屬於細胞色素P450的CYP2B6、CYP2C19、CYP3A4代謝成去甲哌替啶。由於這些酶的活性因人而異，且可能受到共服的其它藥物影響，因此很難預測產生去甲哌替啶的速率。[14][15]
參考資料
- ^ Conversion Factors for Controlled Substances. Diversion Control Division. Drug Enforcement Administration (DEA), U.S. Department of Justice.
- ^ US granted 2858316,Henri M,「New piperidine derivatives」,發表於28 October 1958,指定於UCB SA
- ^ Frearson PM, Stern ES. 622. Some new analogues of pethidine. Part III. 1-Aryloxy-alkylnorpethidines, and close analogues.. Journal of the Chemical Society (Resumed). 1958: 3065–7. doi:10.1039/JR9580003065.
- ^ Frearson PM, Hardy DG, Stern ES. 426. Some new analogues of pethidine. Part IV. Substituents at the 1-position incorporating cyclic ether groups.. Journal of the Chemical Society (Resumed). 1960: 2103–7. doi:10.1039/JR9600002103.
- ^ Umans JG, Inturrisi CE. Antinociceptive activity and toxicity of meperidine and normeperidine in mice. The Journal of Pharmacology and Experimental Therapeutics. October 1982, 223 (1): 203–6. PMID 7120119.
- ^ Plummer JL, Gourlay GK, Cmielewski PL, Odontiadis J, Harvey I. Behavioural effects of norpethidine, a metabolite of pethidine, in rats. Toxicology. January 1995, 95 (1–3): 37–44. PMID 7825188. doi:10.1016/0300-483x(94)02871-q.
- ^ Simopoulos TT, Smith HS, Peeters-Asdourian C, Stevens DS. Use of meperidine in patient-controlled analgesia and the development of a normeperidine toxic reaction. Archives of Surgery (Chicago, Ill.). January 2002, 137 (1): 84–8. PMID 11772223. doi:10.1001/archsurg.137.1.84
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- ^ Stone PA, Macintyre PE, Jarvis DA. Norpethidine toxicity and patient controlled analgesia. British Journal of Anaesthesia. November 1993, 71 (5): 738–40. PMID 8251291. doi:10.1093/bja/71.5.738 .
- ^ Reutens DC, Stewart-Wynne EG. Norpethidine induced myoclonus in a patient with renal failure. Journal of Neurology, Neurosurgery, and Psychiatry. December 1989, 52 (12): 1450–1. PMC 1031622 . PMID 2614458. doi:10.1136/jnnp.52.12.1450.
- ^ Appel WC. Possible roles of normeperidine and hyponatremia in a postoperative death. Canadian Medical Association Journal. November 1987, 137 (10): 912–3. PMC 1267380 . PMID 3676934.
- ^ Jiraki K. Lethal effects of normeperidine. The American Journal of Forensic Medicine and Pathology. March 1992, 13 (1): 42–3. PMID 1585886. S2CID 32005631. doi:10.1097/00000433-199203000-00009.
- ^ Holmberg, L.; Odar-Cederlöf, I.; Boréus, L. O.; Heyner, L.; Ehrnebo, M. Comparative disposition of pethidine and norpethidine in old and young patients. European Journal of Clinical Pharmacology. 1982, 22 (2): 175–179. ISSN 0031-6970. doi:10.1007/BF00542464.
- ^ Pond SM, Tong T, Benowitz NL, Jacob P, Rigod J. Presystemic metabolism of meperidine to normeperidine in normal and cirrhotic subjects. Clinical Pharmacology and Therapeutics. August 1981, 30 (2): 183–8. PMID 7249503. S2CID 10117158. doi:10.1038/clpt.1981.146.
- ^ Ramírez J, Innocenti F, Schuetz EG, Flockhart DA, Relling MV, Santucci R, Ratain MJ. CYP2B6, CYP3A4, and CYP2C19 are responsible for the in vitro N-demethylation of meperidine in human liver microsomes. Drug Metabolism and Disposition: The Biological Fate of Chemicals. September 2004, 32 (9): 930–6. PMID 15319333.
- ^ McHugh GJ. Norpethidine accumulation and generalized seizure during pethidine patient-controlled analgesia. Anaesthesia and Intensive Care. June 1999, 27 (3): 289–91. PMID 10389564.
