Minov Christo
Bezirkskrankenhaus Augsburg.
Psychiatr Prax. 2004 Nov;31 Suppl 1:S142-4. doi: 10.1055/s-2004-828458.
Ziprasidone, a novel antipsychotic agent for the treatment of schizophrenia, undergoes partial metabolism by cytochrome P450 3A4. It is associated with moderate prolongation of QT interval, but no increased risk for ventricular tachyarrhythmia or sudden death was demonstrated.
A 70-year-old male was initiated on quetiapine therapy for an acute exacerbation of chronic schizophrenia. The baseline electrocardiogram (ECG) showed a normal QT interval (QTc: 417 ms). In combination therapy of quetiapine and ziprasidone the patient developed suddenly cardiac arrhythmia with extrasystoles and the ECG revealed a prolonged QTc interval of 482 ms. After breaking off treatment with quetiapine and reduction of ziprasidone a normalized QT interval (QTc: 428 ms) was measured.
We suppose a potential of pharmacokinetic interaction between quetiapine and ziprasidone because of the same metabolic pathway by CYP3A4. Combining treatment of quetiapine and ziprasidone is therefore contraindicated. In addition we suggest caution using ziprasidone with any potential 3A4 substrate or inhibitor.
齐拉西酮是一种用于治疗精神分裂症的新型抗精神病药物，通过细胞色素P450 3A4进行部分代谢。它与QT间期适度延长有关，但未显示室性快速心律失常或猝死风险增加。
一名70岁男性因慢性精神分裂症急性加重开始接受喹硫平治疗。基线心电图（ECG）显示QT间期正常（QTc：417毫秒）。在喹硫平和齐拉西酮联合治疗期间，患者突然出现心律失常伴早搏，心电图显示QTc间期延长至482毫秒。停用喹硫平并减少齐拉西酮剂量后，测得QT间期恢复正常（QTc：428毫秒）。
由于喹硫平和齐拉西酮通过CYP3A4具有相同的代谢途径，我们推测它们之间存在药代动力学相互作用的可能性。因此，喹硫平和齐拉西酮联合治疗是禁忌的。此外，我们建议在使用齐拉西酮与任何潜在的3A4底物或抑制剂时要谨慎。
