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横纹肌溶解症合并阿托伐他汀与地尔硫䓬使用情况

Rhabdomyolysis with concurrent atorvastatin and diltiazem.

作者信息

Lewin John J, Nappi Jean M, Taylor Marian H

机构信息

Critical Care Pharmacy Practice, College of Pharmacy, Medical University of South Carolina, Charleston, SC, USA.

出版信息

Ann Pharmacother. 2002 Oct;36(10):1546-9. doi: 10.1345/aph.1A481.

Abstract

OBJECTIVE

To report a case of rhabdomyolysis and acute hepatitis associated with the coadministration of atorvastatin and diltiazem.

CASE SUMMARY

A 60-year-old African American man with a significant past medical history presented to the emergency department with acute renal failure secondary to rhabdomyolysis. In addition, liver enzymes were elevated to greater than 3 times normal. The only change in medication was the initiation of diltiazem 3 weeks earlier for atrial fibrillation to a complicated medication regimen that included atorvastatin.

DISCUSSION

Rhabdomyolysis has been reported in patients receiving hydroxymethylglutaryl coenzyme A (HMG-CoA) reductase inhibitors when coadministered with agents that may inhibit their metabolism. Atorvastatin is the most potent of this class of agents currently available and is commonly used in the treatment of hyperlipidemia. Rhabdomyolysis resulting from the drug interaction between diltiazem and other HMG-CoA reductase inhibitors has been described in the literature. However, no report has specifically associated this adverse event with atorvastatin and diltiazem. We describe a patient with a complex medication regimen who was admitted for rhabdomyolysis and accompanying acute renal failure, along with acute hepatitis, thought to be secondary to a drug interaction between atorvastatin and diltiazem.

CONCLUSIONS

While optimizing the patient's lipid profile should be the primary factor in choosing one statin over another, the potential for drug interactions requires close attention. All patients beginning HMG-CoA reductase inhibitor therapy should be counseled regarding the signs and symptoms of muscle injury; particular attention should be paid to those patients who are taking medications that may interact.

摘要

目的

报告一例与阿托伐他汀和地尔硫䓬联合使用相关的横纹肌溶解症和急性肝炎病例。

病例摘要

一名60岁有重要既往病史的非裔美国男性因横纹肌溶解继发急性肾衰竭就诊于急诊科。此外,肝酶升高至正常上限的3倍以上。唯一的用药变化是3周前开始使用地尔硫䓬治疗房颤,加入了一个复杂的用药方案,其中包括阿托伐他汀。

讨论

有报道称,接受羟甲基戊二酰辅酶A(HMG-CoA)还原酶抑制剂的患者在与可能抑制其代谢的药物合用时会发生横纹肌溶解。阿托伐他汀是目前这类药物中效力最强的,常用于治疗高脂血症。文献中已描述了地尔硫䓬与其他HMG-CoA还原酶抑制剂之间的药物相互作用导致的横纹肌溶解。然而,尚无报告明确将这一不良事件与阿托伐他汀和地尔硫䓬联系起来。我们描述了一名有复杂用药方案的患者,因横纹肌溶解及伴随的急性肾衰竭以及急性肝炎入院,认为这是阿托伐他汀和地尔硫䓬之间药物相互作用的继发结果。

结论

虽然优化患者的血脂谱应是选择一种他汀类药物而非另一种的主要因素,但药物相互作用的可能性需要密切关注。所有开始接受HMG-CoA还原酶抑制剂治疗的患者都应被告知肌肉损伤的体征和症状;对于正在服用可能相互作用药物的患者应给予特别关注。

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