Hirmerová J, Suchý D, Mádr T
Oddĕlení klinické hematologie FN, Plzen.
Cas Lek Cesk. 2003 Jan 20;142(1):39-42.
Authors describe a case of drug interaction between amiodarone and warfarin in 66-year-old man with recurrent atrial fibrillation. In spite of a relatively low dose of warfarin, prothrombin time became extremely prolonged and bleeding manifestations occurred. Effects of the interaction persisted for a long time after the withdrawal of both drugs. Various approaches to oral anticoagulant reversal are discussed. Pharmacokinetics of both drugs is explained, as well as the mechanism of their interaction through cytochrome P450 inhibition in the liver. Authors emphasize the great interindividual variability and long persistence of this interaction. It is necessary to consider carefully the indication of using these drugs together and when the use is inevitable, it is recommended to lower the warfarin dose to 50-70% and to perform thorough and frequent INR monitoring.
作者描述了一名66岁复发性心房颤动男性患者中胺碘酮与华法林之间的药物相互作用案例。尽管华法林剂量相对较低，但凝血酶原时间变得极度延长并出现了出血表现。两种药物停用后，相互作用的影响仍持续了很长时间。文中讨论了口服抗凝剂逆转的各种方法。解释了两种药物的药代动力学以及它们通过抑制肝脏中的细胞色素P450相互作用的机制。作者强调了这种相互作用存在很大的个体差异且持续时间长。必须仔细考虑同时使用这些药物的指征，当不可避免要同时使用时，建议将华法林剂量降低至50 - 70%，并进行全面且频繁的国际标准化比值（INR）监测。
