Lin Hsiang-Wen, Simonavice Cory A, Lu Chiung-Ray, Lin Wen-Ling, Wu Po-Lun, Chou Che-Yi, Liao Chun-Hui, Lane Hsieh-Yuan
School of Pharmacy and Graduate Institute, College of Pharmacy, China Medical University, No. 91 Hsueh-Shih Road, Taichung, 40402, Taiwan.
Department of Pharmacy, China Medical University Hospital, No. 2 Yuh-Der Road, Taichung, 40447, Taiwan.
BMC Health Serv Res. 2017 Apr 13;17(1):272. doi: 10.1186/s12913-017-2195-2.
Although the prescribing information for Venlafaxine extended release includes a discussion about possible increases in total cholesterol and triglycerides (TG) seen in healthier adult patients during premarketing clinical trials, no post-marketing studies or case reports, that discuss the effects of venlafaxine on TG in elderly patients with chronic kidney disease.
We report a 71 year-old male patient with end-stage renal disease on hemodialysis, with a history of coronary artery disease, mild hyperlipidemia, and hypertension. This patient twice demonstrated the severe rises in triglycerides while taking the antidepressant, i.e., venlafaxine, and discontinuing the long-term use of fenofirate. The adverse drug reaction sub-committee at the hospital rated the second event as a "probable reaction" using the Naranjo nomogram, accordingly.
This case demonstrates the risk of changes in lipid profiles while taking venlafaxine and receiving on and off fenofibrate therapy in the older adult patient with chronic kidney disease and under hemodialysis. Regular monitoring for lipid changes after starting venlafaxine is strongly advised for patients with existing risk factors.
尽管文拉法辛缓释片的处方信息中包含了关于在上市前临床试验中健康成年患者总胆固醇和甘油三酯（TG）可能升高的讨论，但尚无上市后研究或病例报告探讨文拉法辛对老年慢性肾脏病患者TG的影响。
我们报告了一名71岁男性患者，患有终末期肾病并接受血液透析，有冠状动脉疾病、轻度高脂血症和高血压病史。该患者在服用抗抑郁药文拉法辛并停用长期使用的非诺贝特后，甘油三酯两次出现严重升高。医院的药物不良反应小组委员会据此使用纳兰霍量表将第二次事件评定为“可能的反应”。
该病例表明，老年慢性肾脏病且接受血液透析的患者在服用文拉法辛并间断接受非诺贝特治疗时，存在血脂谱改变的风险。对于有现有风险因素的患者，强烈建议在开始服用文拉法辛后定期监测血脂变化。
