Takami N, Yamamoto Y, Matsuo H, Ohtani H, Sawada Y
Chubutokusyukai Hospital, Okinawa, Japan.
Int J Clin Pharmacol Ther. 2002 Nov;40(11):520-3. doi: 10.5414/cpp40520.
A 70-year-old Japanese woman with renal dysfunction under hemodialysis presented with vomiting and chill with fever. Over the previous 24 weeks she had been taking 75 mg of ranitidine after hemodialysis. Other medications taken were prednisolone, furosemide, alpha-calcidol, amlodipine and calcium carbonate. Before starting ranitidine, she had been treated with famotidine for about 2 years without complication. Hematological inspection on admission revealed agranulocytosis with WBC of 400/mm3. Ranitidine was discontinued and granulocyte colony-stimulating factor (G-CSF) was started. On Day 3, laboratory data showed slight improvement of cytopenia with WBC of 1,000/mm3. On Day 6, her hemogram showed marked improvement with WBC of 11,700/mm3 and G-CSF was discontinued. She was discharged on Day 10. Several cases describing ranitidine-induced cytopenia are associated with the use of ranitidine at a dose of 150 mg/day or higher, and adverse reactions were found within 2-35 days after beginning ranitidine treatment. In the case described here, however, the adverse reaction occurred after a longer treatment period with ranitidine at a lower dose. In conclusion, ranitidine should be administered with great caution to patients with severe renal dysfunction.
一名70岁接受血液透析且伴有肾功能不全的日本女性，出现呕吐、寒战及发热症状。在过去24周里，她在血液透析后服用75毫克雷尼替丁。她还服用其他药物，包括泼尼松龙、呋塞米、阿法骨化醇、氨氯地平和碳酸钙。在开始服用雷尼替丁之前，她曾接受法莫替丁治疗约2年，未出现并发症。入院时血液学检查显示粒细胞缺乏症，白细胞计数为400/mm³。停用雷尼替丁并开始使用粒细胞集落刺激因子（G-CSF）。第3天，实验室数据显示血细胞减少略有改善，白细胞计数为1000/mm³。第6天，她的血常规显示明显改善，白细胞计数为11700/mm³，停用G-CSF。她于第10天出院。几例描述雷尼替丁引起血细胞减少的病例与使用150毫克/天或更高剂量的雷尼替丁有关，且在开始雷尼替丁治疗后2至35天内发现不良反应。然而，在本文所述病例中，不良反应发生在较低剂量雷尼替丁较长治疗期之后。总之，对于严重肾功能不全患者，使用雷尼替丁应极为谨慎。
