Zhao Hai-Feng, Sun Jia-Hui, Liu Shuang, Liu Yan, Liu Gao-Feng
Department of Pharmacy, the Second Affiliated Hospital of Harbin Medical University, Key Laboratory of University in Heilongjiang Province, Harbin 150086, China.
Zhongguo Zhong Yao Za Zhi. 2017 Mar;42(5):982-988. doi: 10.19540/j.cnki.cjcmm.20170121.029.
To explore the effect of Shuxuetong injection on the pharmacodynamics and pharmacokinetics of warfarin in rats, and to provide reference for rational drug use. In studies on the single dose of warfarin, Wistar rats were randomly divided into four groups: blank control group(group A), Shuxuetong injection group(group B), warfarin control group(group C), and warfarin+Shuxuetong injection group(group D). In studies on the steady state of warfarin, Wistar rats were randomly divided into warfarin control group(group E) and warfarin+Shuxuetong injection group(group F). To investigate the pharmacodynamic effect of Shuxuetong injection on warfarin, prothrombin time(PT) and activated partial thromboplastin time(APTT) were measured by coagulation analyzer, and international normalized ratio(INR) was calculated. To investigate the pharmacokinetic effect of Shuxuetong injection on warfarin, the blood concentrations of S-warfarin and R-warfarin were determined by UPLC-MS/MS combined with technology of chiral chromatographic column, and the related pharmacokinetic parameters were calculated accordingly. The results on the single dose of warfarin showed that Shuxuetong injection markedly increased PT, INR(P<0.01), and APTT(P<0.05). Meanwhile, when Shuxuetong injection was co-administrated with warfarin, it significantly increased PT, INR(P<0.01), and APTT(P<0.05) as compared with warfarin control group. In addition, increased pharmacokinetic parameters including Cmax, AUC0-t and AUC0-∞, prolonged t1/2, and decreased CL/F were observed for S-warfarin and R-warfarin. The results of the steady state of warfarin suggested that Shuxuetong injection significantly increased PT and INR of warfarin(P<0.01), and elevated the plasma concentrations of S-warfarin and R-warfarin when co-administrated with warfarin. These findings indicated that Shuxuetong injection had anticoagulant effect, and would produce pharmacodynamics synergistic action when it was co-administrated with warfarin. Shuxuetong injection also decelerated the metabolism of warfarin, and resulted in pharmacokinetics interaction. Therefore, Shuxuetong injection could significantly increase anticoagulant effect of warfarin, indicating that the combination use of these two drugs should be refrained in order to avoid the risk of bleeding in clinical application. If they need to be used in combination, special attention should be paid to ensure the safety of patients.
探讨舒血宁注射液对大鼠华法林药效学及药代动力学的影响,为合理用药提供参考。在华法林单次给药研究中,将Wistar大鼠随机分为四组:空白对照组(A组)、舒血宁注射液组(B组)、华法林对照组(C组)、华法林+舒血宁注射液组(D组)。在华法林稳态研究中,将Wistar大鼠随机分为华法林对照组(E组)和华法林+舒血宁注射液组(F组)。为考察舒血宁注射液对华法林的药效学影响,采用凝血分析仪测定凝血酶原时间(PT)和活化部分凝血活酶时间(APTT),并计算国际标准化比值(INR)。为考察舒血宁注射液对华法林的药代动力学影响,采用超高效液相色谱-串联质谱联用手性色谱柱技术测定S-华法林和R-华法林的血药浓度,并计算相关药代动力学参数。华法林单次给药结果显示,舒血宁注射液显著升高PT、INR(P<0.01)及APTT(P<0.05)。同时,舒血宁注射液与华法林合用时,与华法林对照组相比,显著升高PT、INR(P<0.01)及APTT(P<0.05)。此外,S-华法林和R-华法林的药代动力学参数Cmax、AUC0-t及AUC0-∞升高,t1/2延长,CL/F降低。华法林稳态结果表明,舒血宁注射液显著升高华法林的PT和INR(P<0.01),与华法林合用时升高S-华法林和R-华法林的血浆浓度。这些结果表明,舒血宁注射液具有抗凝作用,与华法林合用时会产生药效学协同作用。舒血宁注射液还减慢了华法林的代谢,导致药代动力学相互作用。因此,舒血宁注射液可显著增强华法林的抗凝作用,提示临床应用时应避免两药联用,以防止出血风险。若需联用,应特别注意确保患者安全。