Zhang Xiao-Meng, Li Fan, Zhang Bing, Chen Xiao-Fen, Piao Jing-Zhu
Beijing University of Chinese Medicine, Beijing 100029, China.
Zhongguo Zhong Yao Za Zhi. 2018 Jan;43(2):216-221. doi: 10.19540/j.cnki.cjcmm.20171106.006.
The common Aconitum herbs in clinical application mainly include Aconiti Radix(Chuanwu), Aconiti Kusnezoffii Radix(Caowu) and Aconiti Lateralis Radix Praeparaia(Fuzi), all of which have toxicity. Therefore, the safety of using Chinese patent drugs including Aconitum herbs has become an hot topic in clinical controversy. Based on the data-mining methods, this study explored the characteristics and causes of adverse drug reactions/events (ADR/ADE) of the Chinese patent drugs including Aconitum, in order to provide pharmacovigilance and rational drug use suggestions for clinical application. The detailed ADR/ADE reports about the Chinese patent drugs including Aconitum herbs were retrieved in the domestic literature databases since 1984 to now. The information extraction and data-mining were conducted based on the platforms of Microsoft office Excel 2016, Clementine 12.0 and Cytoscape 3.3.0. Finally, 78 detailed ADR/ADE reports involving a total of 30 varieties were included. 92.31% ADR/ADE were surely or likely led by the Chinese patent drugs including Aconitum, mostly involving multiple system/organ damages with good prognosis, and even 1 case of death. The incidence of included ADRs/ADEs was associated with various factors such as the patient idiosyncratic, drug toxicity, as well as clinical medication. The patient age was most closely related to ADR/ADEs, and those aged from 60 to 69 were more easily suffered from the ADRs/ADEs of Chinese patent drugs including Aconitum. The probability of ADR/ADEs for the drugs including Chuanwu or Caowu was greater than that of Fuzi, and the using beyond the instructions dose was the most important potential safety hazard in the clinical medication process. For the regular and characteristics of ADR/ADEs led by Chinese patent drugs including Aconitum, special attention shall be paid to the elder patients or with the patients with allergies; strictly control the dosage and course of treatment, strengthen the safety medication education to public, and avoid misuse or abuse to ensure rational drug use.
临床应用中常用的乌头类药材主要有川乌、草乌和附子,均具有毒性。因此,含乌头类药材中成药使用的安全性成为临床争议的热点话题。本研究基于数据挖掘方法,探讨含乌头类中成药不良反应/不良事件(ADR/ADE)的特点及成因,为临床应用提供药物警戒及合理用药建议。检索1984年至今国内文献数据库中含乌头类药材中成药的详细ADR/ADE报告。基于Microsoft office Excel 2016、Clementine 12.0和Cytoscape 3.3.0平台进行信息提取和数据挖掘。最终纳入78份详细ADR/ADE报告,涉及30个品种。92.31%的ADR/ADE肯定或很可能由含乌头类中成药引起,多累及多系统/器官损害,预后良好,甚至有1例死亡。纳入的ADR/ADE发生率与患者个体差异、药物毒性以及临床用药等多种因素有关。患者年龄与ADR/ADE关系最为密切,60~69岁者更容易发生含乌头类中成药的ADR/ADE。含川乌或草乌的药物发生ADR/ADE的概率大于附子,临床用药过程中超出说明书剂量使用是最重要的潜在安全隐患。针对含乌头类中成药所致ADR/ADE的规律和特点,应特别关注老年患者或过敏体质患者;严格控制剂量和疗程,加强公众安全用药教育,避免误用、滥用,确保合理用药。