奥美拉唑使用的安全性评估:一项综述。
Safety assessment of omeprazole use: a review.
作者信息
Forgerini Marcela, Mieli Stephania, Mastroianni Patrícia de Carvalho
机构信息
BSc. Pharmacist and Master's Student in the Postgraduate Program on Pharmaceutical Sciences, Universidade Estadual Paulista (UNESP), Araraquara (SP), Brazil.
Undergraduate Pharmacy Student, Universidade Estadual Paulista (UNESP), Araraquara (SP), Brazil.
出版信息
Sao Paulo Med J. 2018 Nov-Dec;136(6):557-570. doi: 10.1590/1516-3180.2018.0019220318.
BACKGROUND
Risks regarding hospital admission due to adverse drug reactions and drug interactions from use of omeprazole have been reported. The question guiding the present review was "Which adverse events occur in patients using omeprazole in a Food and Drug Administration-approved and/or off-label manner?" It was also proposed to evaluate the safety of use of omeprazole.
DESIGN AND SETTING
Qualitative narrative review with critical evaluation, in a public university.
METHODS
The PubMed, SCOPUS, LILACS, SciELO, EMBASE and EBSCO databases were searched on July 31, 2018. Studies evaluating adverse events were screened.
RESULTS
72 articles were included, among which 58 reported on adverse drug events (47, adverse drug reactions; 5, drug interactions; and 6, situations of ineffectiveness). 28 adverse drug reactions not described in compendia and drug leaflets were described in these studies: myocardial infarction (6); stroke (2); spontaneous abortion (1); proliferative changes (1); chills (1); heart failure (1); thrombosis (2); and dementia (1), among others. Severe adverse reactions, for instance cardiac problems, Steven-Johnson syndrome and proliferative changes, were identified. The antiplatelet effects of drugs such as clopidogrel, in patients who underwent heart-related surgery, increased the risk of developing cardiac problems, such as cardiovascular death, myocardial infarction and stroke. In newly transplanted patients, decreased absorption of mycophenolate mofetil occurred, thus leading to rejection of transplanted organs.
CONCLUSION
Use of omeprazole should be monitored primarily in patients with heart disorders using antiplatelet agents concomitantly, and in newly transplanted patients using mycophenolic acid, in order to avoid serious adverse reactions.
背景
已有报告指出使用奥美拉唑导致药物不良反应及药物相互作用而入院的风险。本综述所依据的问题是“以美国食品药品监督管理局批准和/或未按标签说明使用方式使用奥美拉唑的患者会发生哪些不良事件?”同时还提议评估使用奥美拉唑的安全性。
设计与地点
在一所公立大学进行的带有批判性评估的定性叙述性综述。
方法
于2018年7月31日检索了PubMed、SCOPUS、LILACS、SciELO、EMBASE和EBSCO数据库。筛选评估不良事件的研究。
结果
纳入72篇文章,其中58篇报告了药物不良事件(47例为药物不良反应;5例为药物相互作用;6例为无效情况)。这些研究描述了28种在药典和药品说明书中未提及的药物不良反应:心肌梗死(6例);中风(2例);自然流产(1例);增殖性改变(1例);寒战(1例);心力衰竭(1例);血栓形成(2例);痴呆(1例)等。还识别出了严重不良反应,如心脏问题、史蒂文斯 - 约翰逊综合征和增殖性改变。在接受心脏相关手术的患者中,氯吡格雷等药物的抗血小板作用增加了发生心脏问题的风险,如心血管死亡、心肌梗死和中风。在新移植患者中,霉酚酸酯的吸收减少,从而导致移植器官排斥。
结论
对于同时使用抗血小板药物的心脏病患者以及使用霉酚酸的新移植患者,应主要监测奥美拉唑的使用情况,以避免严重不良反应。