Mayo Clinic Alix School of Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA.
Department of Neurology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA.
Pharmacogenomics. 2020 Apr;21(6):387-392. doi: 10.2217/pgs-2019-0136. Epub 2020 Apr 14.
Subarachnoid hemorrhage is a devastating form of stroke with often detrimental outcomes for patients. Here we describe a patient with subarachnoid hemorrhage treated with nimodipine, which resulted in marked bradycardia with junctional atrioventricular heart block. Nimodipine is metabolized predominantly by the cytochrome P450 3A subfamily, and its use is often associated with adverse events, such as hypotension and bradycardia, which can be exacerbated by advanced age. Our patient had the genotype, possibly predisposing her to poor metabolism of this drug. Our case report demonstrates the potential for pharmacogenomics in patients with subarachnoid hemorrhage to help predict their response to nimodipine, minimize adverse drug reactions, and potentially individualize dosing to improve future clinical outcomes.
蛛网膜下腔出血是一种具有破坏性的中风形式，常使患者预后不良。在这里，我们描述了一例使用尼莫地平治疗蛛网膜下腔出血的患者，该患者出现明显的心动过缓伴交界性房室传导阻滞。尼莫地平主要通过细胞色素 P450 3A 亚家族代谢，其使用常与不良反应相关，如低血压和心动过缓，这些反应在老年患者中可能更为严重。我们的患者携带 基因型，可能使她对这种药物的代谢不良。我们的病例报告表明，蛛网膜下腔出血患者的药物基因组学具有潜在的作用，可以帮助预测他们对尼莫地平的反应，减少药物不良反应，并可能实现个体化剂量以改善未来的临床结果。
