CHRU de Tours, Service de Pharmacosurveillance, Centre Régional de Pharmacovigilance Centre-Val de Loire, Tours, 37044, France.
Université Grenoble Alpes, INSERM, HP2, Grenoble, 38000, France.
Br J Clin Pharmacol. 2021 Aug;87(8):3043-3055. doi: 10.1111/bcp.14752. Epub 2021 Feb 20.
Many drugs are responsible, through different mechanisms, for peripheral oedema. Severity is highly variable, ranging from slight oedema of the lower limbs to anasarca pictures as in the capillary leak syndrome. Although most often noninflammatory and bilateral, some drugs are associated with peripheral oedema that is readily erythematous (eg, pemetrexed) or unilateral (eg, sirolimus). Thus, drug-induced peripheral oedema is underrecognized and misdiagnosed, frequently leading to a prescribing cascade. Four main mechanisms are involved, namely precapillary arteriolar vasodilation (vasodilatory oedema), sodium/water retention (renal oedema), lymphatic insufficiency (lymphedema) and increased capillary permeability (permeability oedema). The underlying mechanism has significant impact on treatment efficacy. The purpose of this review is to provide a comprehensive analysis of the main causative drugs by illustrating each pathophysiological mechanism and their management through an example of a drug.
许多药物通过不同的机制导致外周水肿。严重程度差异很大，从下肢轻度水肿到毛细血管渗漏综合征的全身性水肿不等。虽然大多数外周水肿是非炎症性和双侧的，但有些药物与容易出现红斑的外周水肿（如培美曲塞）或单侧水肿（如西罗莫司）有关。因此，药物引起的外周水肿被低估和误诊，经常导致处方泛滥。涉及四个主要机制，即毛细血管前小动脉扩张（血管扩张性水肿）、钠/水潴留（肾水肿）、淋巴功能不全（淋巴水肿）和毛细血管通透性增加（通透性水肿）。潜在机制对治疗效果有重大影响。本文的目的是通过举例说明每个病理生理机制及其管理，对主要致病药物进行全面分析。
