伏立康唑少见不良反应3例报道并文献复习
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摘要
目的探讨伏立康唑治疗过程中发生的药物不良反应,提醒临床医师和药师对伏立康唑相关不良反应引起重视。方法报道2例基础疾病复杂的侵袭性肺部真菌病患者,使用伏立康唑过程中出现声音嘶哑,停用伏立康唑后声音嘶哑消失。报道1例侵袭性肺曲霉病老年患者使用伏立康唑治疗,合并使用塞来昔布治疗过程中患者出现明显乏力、肌痛,检测肌酸激酶升高,先后停用塞来昔布及伏立康唑后,肌酸激酶恢复正常。结果声音嘶哑是伏立康唑所致不良反应的可能性大,而药物性肌病的不良反应是伏立康唑增加了塞来昔布的血药浓度,导致肌痛发生。结论密切关注临床用药安全,注意药物之间相互作用,监测血药浓度。
Objective To investigate the adverse effects of voriconazole during the course of treatment, and to remind clinicians and pharmacists to pay attention to the adverse reactions of voriconazole. Methods Two cases of patients with complex underlying disease of invasive pulmonary fungal infections were reported, and we found that the voice hoarse appeared in the process of using voriconazole, and disappeared after stopping the use of voriconazole.One case of voriconazole-treated invasive pulmonary aspergillos is in elderly patient was reported. The patient was co-treated with celecoxib, and was significantly weak. Myalgia appeared in the course of treatment. Biochemical tests showed that the levels of creatine kinase increased. After discontinuation of celecoxib and voriconazole, the levels of creatine kinase returned to normal. Results Hoarseness is probably an adverse reaction caused by voriconazole, and the adverse effects of drug myopathy are due to the fact that voriconazole increased the concentration of celecoxib in plasma, leading to myasthenia. Conclusion Clinicians and pharmacists should pay close attention to the clinical drug safety, pay attention to the drug-drug interactions, and monitor the drug concentrations in plasma.
Objective To investigate the adverse effects of voriconazole during the course of treatment, and to remind clinicians and pharmacists to pay attention to the adverse reactions of voriconazole. Methods Two cases of patients with complex underlying disease of invasive pulmonary fungal infections were reported, and we found that the voice hoarse appeared in the process of using voriconazole, and disappeared after stopping the use of voriconazole.One case of voriconazole-treated invasive pulmonary aspergillos is in elderly patient was reported. The patient was co-treated with celecoxib, and was significantly weak. Myalgia appeared in the course of treatment. Biochemical tests showed that the levels of creatine kinase increased. After discontinuation of celecoxib and voriconazole, the levels of creatine kinase returned to normal. Results Hoarseness is probably an adverse reaction caused by voriconazole, and the adverse effects of drug myopathy are due to the fact that voriconazole increased the concentration of celecoxib in plasma, leading to myasthenia. Conclusion Clinicians and pharmacists should pay close attention to the clinical drug safety, pay attention to the drug-drug interactions, and monitor the drug concentrations in plasma.
引文
[1]Denning D W,Ribaud P,Milpied N,et al.Efficacy and safety of voriconazole in the treatment of acute invasive aspergillosis[J].Clin Infect Dis,2002,34(5):563-571.
[2]Pearson M M,Rogers P D,Cleary J D,et al.Voriconazole:A new triazole antifungal agent[J].Ann Pharmacother,2003,36(5):420-432.
[3]Jacobs F,Selleslag D,Aoun M,et al.An observational efficacy and safety analysis of the treatment of acute invasive aspergillosis using voriconazole[J].Eur J Clin Microbiol Infect Dis,2012,31(6):1173-1179.
[4]Haft S,Farquhar D,Carey R,et al.Anticholinergic use is a major risk factor for dysphonia[J].Ann Otol Rhinol Laryngol,2015,124(10):797-802.
[5]Saavedra E,Hollebecque A,Soria J C,et al.Dysphonia induced by anti-angiogenic compounds[J].Invest New Drugs,2014,32(4):774-782.
[6]Lavy J A,Wood G,Rubin J S,et al.Dysphonia associated with inhaled steroids[J].J Voice,2000,14(4):581-588.
[7]John M,Del Gaudio M D.Steroid inhaler laryngitis:Dysphonia caused by inhaled fluticasone therapy[J].Arch Otolaryngol Head Neck Surg,2002,128(6):677-681.
[8]Williamson I J,Matusiewicz S P,Brown P H,et al.Frequency of voice problems and cough in patients using pressurized aerosol inhaled steroid preparations[J].Eur Respir J,1995,8(4):590.
[9]Lees R S, Lees A M. Rhabdomyolysis from the coadministration of lovastatin and the antifungal agent itraconazole[J].N Engl J Med,1995,333(10):664-665.
[10]Ferrari M,Bodini I,Lo Cascio V.Rhabdomyolysis after the administration of itraconazole to an asthmatic patient with bronchopulmonary aspergillosis[J].Respiration,2004,71(3):289-291.
[11]Kantola T,Kivisto K T,Neuvonen P J.Effect of itraconazole on the pharmacokinetics of atorvastatin[J].Clin Pharmacol Ther,1998,64(1):58-65.
[12]Shanmugam V K,Matsumoto C,Pien E,et al.Voriconazoleassociated myositis[J].J Clin Rheumatol,2009,15(7):350-353.
[13]曲彩红,雷姿颖.伏立康唑与埃索美拉唑联用致乙肝肝硬化并肺部侵袭性真菌感染患者横纹肌溶解症[J].今日药学,2011,21(11):686-688.
[14]曲彩红,黎小妍.伏立康唑与奥美拉唑可能的不良相互作用致肌病及肝功能恶化[J].药物不良反应杂志,2011,13(6):374-377.
[15]Uckner J.Drug-related myopathies[J].Rheum Dis Clin North Am,1994,20(4):1017.
[16]Prendergast B D,George C F.Drug-induced rhabdomyolysis--mechanisms and management[J].Postgrad Med J,1993,69(811):333-336.
[17]Curry S C,Chang D,Connor D.Drug-and toxin-induced rhabdomyolysis[J].Ann Emerg Med,1989,18(10):1068.
[18]Martindale:The complete drug reference,38th,2205-2206.
[19]https://en.wikipedia.org/wiki/Propylene_glycol#Safety_in_humans.
[2]Pearson M M,Rogers P D,Cleary J D,et al.Voriconazole:A new triazole antifungal agent[J].Ann Pharmacother,2003,36(5):420-432.
[3]Jacobs F,Selleslag D,Aoun M,et al.An observational efficacy and safety analysis of the treatment of acute invasive aspergillosis using voriconazole[J].Eur J Clin Microbiol Infect Dis,2012,31(6):1173-1179.
[4]Haft S,Farquhar D,Carey R,et al.Anticholinergic use is a major risk factor for dysphonia[J].Ann Otol Rhinol Laryngol,2015,124(10):797-802.
[5]Saavedra E,Hollebecque A,Soria J C,et al.Dysphonia induced by anti-angiogenic compounds[J].Invest New Drugs,2014,32(4):774-782.
[6]Lavy J A,Wood G,Rubin J S,et al.Dysphonia associated with inhaled steroids[J].J Voice,2000,14(4):581-588.
[7]John M,Del Gaudio M D.Steroid inhaler laryngitis:Dysphonia caused by inhaled fluticasone therapy[J].Arch Otolaryngol Head Neck Surg,2002,128(6):677-681.
[8]Williamson I J,Matusiewicz S P,Brown P H,et al.Frequency of voice problems and cough in patients using pressurized aerosol inhaled steroid preparations[J].Eur Respir J,1995,8(4):590.
[9]Lees R S, Lees A M. Rhabdomyolysis from the coadministration of lovastatin and the antifungal agent itraconazole[J].N Engl J Med,1995,333(10):664-665.
[10]Ferrari M,Bodini I,Lo Cascio V.Rhabdomyolysis after the administration of itraconazole to an asthmatic patient with bronchopulmonary aspergillosis[J].Respiration,2004,71(3):289-291.
[11]Kantola T,Kivisto K T,Neuvonen P J.Effect of itraconazole on the pharmacokinetics of atorvastatin[J].Clin Pharmacol Ther,1998,64(1):58-65.
[12]Shanmugam V K,Matsumoto C,Pien E,et al.Voriconazoleassociated myositis[J].J Clin Rheumatol,2009,15(7):350-353.
[13]曲彩红,雷姿颖.伏立康唑与埃索美拉唑联用致乙肝肝硬化并肺部侵袭性真菌感染患者横纹肌溶解症[J].今日药学,2011,21(11):686-688.
[14]曲彩红,黎小妍.伏立康唑与奥美拉唑可能的不良相互作用致肌病及肝功能恶化[J].药物不良反应杂志,2011,13(6):374-377.
[15]Uckner J.Drug-related myopathies[J].Rheum Dis Clin North Am,1994,20(4):1017.
[16]Prendergast B D,George C F.Drug-induced rhabdomyolysis--mechanisms and management[J].Postgrad Med J,1993,69(811):333-336.
[17]Curry S C,Chang D,Connor D.Drug-and toxin-induced rhabdomyolysis[J].Ann Emerg Med,1989,18(10):1068.
[18]Martindale:The complete drug reference,38th,2205-2206.
[19]https://en.wikipedia.org/wiki/Propylene_glycol#Safety_in_humans.