Clinical Pharmacology Department and EA 4275 Biostatistique, Recherche Clinique et Mesures Subjectives en Santé, Hospital of the University of Nantes, Nantes, France.
J Clin Rheumatol. 2011 Jan;17(1):28-30. doi: 10.1097/RHU.0b013e3182056042.
We report a case of colchicine-induced rhabdomyolysis in a heart/lung-transplanted man treated with cyclosporin. A treatment was to resolve an acute gouty arthritis and was started with 3 mg of colchicine the first day, then 2 mg the second and the third day, and finally 1 mg/d during 6 days. Eight days later, the patient developed multiple organ failure and rhabdomyolysis. The concentration of colchicine analyzed was greater than the standard 153 hours after his last intake. Pharmacokinetic interactions are responsible of this toxicity. Cyclosporin, pravastatin, and azithromycin are known to inhibit P-glycoprotein, which will enhance the intracellular colchicine level by acting in its bioavailability and moderating hepatic and renal excretion. Moreover, long-term treatment by cyclosporin generates chronic renal failure that will, in the same time, decrease colchicine elimination. Even short-term administration of therapeutic colchicine dose may cause colchicine-related toxicity, especially in the setting of a renal failure and/or polymedicinal treatment.
我们报告了一例环孢素治疗的心肺移植患者因秋水仙碱引起的横纹肌溶解症。该患者因急性痛风性关节炎接受治疗，首剂给予 3 mg 秋水仙碱，第 2 天和第 3 天给予 2 mg，第 6 天开始每天 1 mg，共 6 天。8 天后，患者发生多器官功能衰竭和横纹肌溶解症。在最后一次服用秋水仙碱 153 小时后，检测到的秋水仙碱浓度高于标准。药代动力学相互作用导致了这种毒性。环孢素、普伐他汀和阿奇霉素已知可抑制 P-糖蛋白，这将通过影响其生物利用度和调节肝、肾功能来增加细胞内秋水仙碱水平。此外，环孢素的长期治疗会导致慢性肾衰竭，同时也会降低秋水仙碱的消除率。即使是短期给予治疗剂量的秋水仙碱也可能导致秋水仙碱相关的毒性，特别是在肾衰竭和/或多药物治疗的情况下。
