Campbell Sarah C, Stockmann Chris, Balch Alfred, Clark Erin A S, Kamyar Manijeh, Varner Michael, Korgenski E Kent, Bonkowsky Joshua L, Spigarelli Michael G, Sherwin Catherine M T
*Division of Clinical Pharmacology, Department of Pediatrics, University of Utah; †Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah School of Medicine; ‡Intermountain Healthcare, Women and Newborns Clinical Program; §Intermountain Healthcare, Pediatric Clinical Program; and ¶Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah.
Ther Drug Monit. 2014 Aug;36(4):544-8. doi: 10.1097/FTD.0000000000000050.
This study sought to determine the frequency of possible cardiopulmonary drug-drug interactions among pregnant women who received intrapartum magnesium sulfate (MgSO4).
Pregnant women admitted to an Intermountain Healthcare facility between January 2009 and October 2011 were studied, if they received 1 or more doses of MgSO4. Concomitant medications were electronically queried from an electronic health records system. Adverse events were identified using administrative discharge codes. The frequency of cardiopulmonary drug-drug interactions was compared among women who did, and did not, receive aminoglycoside antibiotics, antacids/laxatives, calcium channel blockers, corticosteroids, diuretics, neuromuscular blocking agents, and vitamin D analogs, all of which were contraindicated for patients receiving MgSO4.
Overall, 683 women received intrapartum MgSO4 during the study period. A total of 219 MgSO4 potentially interacting drugs were identified among 155 (23%) unique patients. The most commonly identified potentially interacting agents included calcium channel blockers (26%), diuretics (25%), and antacids/laxatives (19%). Longer hospital stays were significantly associated with increasing numbers of MgSO4 interacting drugs (P < 0.001). Three of 53 (6%) women who received furosemide experienced a cardiac arrest, compared with 0 of 618 (0%) women who did not receive furosemide (Fisher exact test, P < 0.001).
Intrapartum administration of drugs that interact with MgSO4 is common and associated with prolonged hospital stays and potentially cardiopulmonary drug-drug interactions. Caution is warranted when prescribing MgSO4 in combination with known interacting medications.
本研究旨在确定接受产时硫酸镁（MgSO4）治疗的孕妇中可能发生的心肺药物相互作用的频率。
对2009年1月至2011年10月间入住山间医疗保健机构且接受1剂或更多剂MgSO4治疗的孕妇进行研究。通过电子健康记录系统对其同时使用的药物进行电子查询。使用出院管理代码识别不良事件。比较接受和未接受氨基糖苷类抗生素、抗酸剂/泻药、钙通道阻滞剂、皮质类固醇、利尿剂、神经肌肉阻滞剂和维生素D类似物的女性中心肺药物相互作用的频率，所有这些药物对接受MgSO4治疗的患者均为禁忌。
总体而言，在研究期间有683名女性接受了产时MgSO4治疗。在155名（23%）不同患者中总共识别出219种可能与MgSO4相互作用的药物。最常识别出的可能相互作用药物包括钙通道阻滞剂（26%）、利尿剂（25%）和抗酸剂/泻药（19%）。住院时间延长与MgSO4相互作用药物数量增加显著相关（P < 0.001）。接受呋塞米的53名女性中有3名（6%）发生心脏骤停，而未接受呋塞米的618名女性中无一例（0%）发生（Fisher精确检验，P < 0.001）。
产时使用与MgSO4相互作用的药物很常见，且与住院时间延长以及潜在的心肺药物相互作用有关。在开具MgSO4与已知相互作用药物的联合处方时需谨慎。
