洗腎患者有時候也會遇到疼痛的問題,如:腳嚴重抽筋之後的肌肉疼痛,或者周邊動脈不通導致的缺血痛,痛風、或糖尿病神經病變,又或者是不小心跌倒了之後,撞到骨裂或骨折了。一般的疼痛,用普拿疼可以減輕症狀,但是如骨頭的痛、或缺血的痛,都不好處理。
患者有時因為疼痛難以處理,醫師為了讓止痛效果更好,會開立一種含有 Tramadol成分的藥物,英文商品名 Ultracet®,中文商品名:及通安®。效果比較好確實沒錯,不過……
小心劑量以及使用頻率
根據文獻,健康的人體內代謝 tramadol的半衰期是6-8小時,因此一般劑量是一天3-4次沒問題,但是,當腎臟功能不好的時候,半衰期會延長變成 12個小時,所以,當中重度腎臟衰竭時(eGFR <30 ml/min/1.73 m2),Ultracet®應該要減量,且減少使用頻率。下表是參照“麻醉醫學臨床藥理學期刊”中文章的表格資料。
成分名 | 正常或輕微腎功能不全 | 中度以上腎功能不全 | 嚴重腎功能不全或已經洗腎者 |
---|
Tramadol (一顆及通安 含有37.5mg) | 25-50 mg,1天4次。 | 25 mg,一天3-4次。 | 25 mg,1天2-3次。 |
我們常用的 Ultracet一顆裡頭含有 37.5 mg的 Tramadol,對照上表可知,若是洗腎患者,一天最多吃早晚各一顆就好,不要過量。另一種方式是一次吃 0.5顆,就可以一天吃 3-4次。
如果是第三期或第四期腎臟病的患者,最好也要減量,一天吃到三顆就有點超過了呢…
Tramadol過量會怎麼樣?
它的代謝物(M1,O-desmethyltramadol),如果沒排出而累積在體內的話,會導致嗜睡,甚至容易癲癇發作,不可不慎。
最後,不管在哪一家醫院或診所,拿了甚麼藥物,最好都拿回洗腎室,給醫師檢查一下再用藥才安全喔。
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