Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Neonatology. 2021;118(3):354-358. doi: 10.1159/000514380. Epub 2021 Mar 29.
Sildenafil is a selective phosphodiesterase type-5 inhibitor that is increasingly used to treat pulmonary hypertension (PH) in neonates. Only little is known about the relation between the dose of sildenafil, plasma concentrations, and the degree of toxicity. Here, we present a young infant with congenital diaphragmatic hernia and PH who received an unintentional 10-fold overdose of oral sildenafil for 6 consecutive days. This overdose, compared to the therapeutic dose, resulted in increased plasma concentrations of sildenafil from 42 to 521 mcg/L and desmethylsildenafil from 81 to 393 mcg/L. However, the high exposure only led to diarrhea, without any other serious adverse events. This case describes the mild symptoms upon an overdose with the role of therapeutic drug monitoring to monitor exposure in relation to symptoms and therewith support clinical decision-making.
西地那非是一种选择性磷酸二酯酶 5 抑制剂，越来越多地用于治疗新生儿肺动脉高压 (PH)。人们对西地那非的剂量、血浆浓度与毒性程度之间的关系知之甚少。在这里，我们介绍了一名患有先天性膈疝和 PH 的婴儿，他在连续 6 天内意外服用了 10 倍剂量的口服西地那非。与治疗剂量相比，这种过量用药导致西地那非的血浆浓度从 42 增至 521 mcg/L，去甲基西地那非从 81 增至 393 mcg/L。然而，高暴露量仅导致腹泻，没有任何其他严重的不良事件。该病例描述了过量用药时出现的轻微症状，说明了治疗药物监测在监测暴露量与症状之间的作用，从而支持临床决策。
