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严重的继发性高钾血症和心律失常:钙通道阻滞剂与伏立康唑药物相互作用的病例报告。

Severe secondary hyperkalemia and arrhythmia from drug interactions between calcium-channel blocker and voriconazole: a case presentation.

机构信息

Department of Nephrology, Peking University People's Hospital, Beijing, China.

Department of pharmacy, Peking University People's Hospital, Beijing, China.

出版信息

BMC Nephrol. 2021 May 10;22(1):172. doi: 10.1186/s12882-021-02370-6.

Abstract

BACKGROUND

Patients with kidney disease may have concurrent hypertension and infection. Dihydropyridine calcium-channel blockers (CCB) are the most popular class of antihypertensive drugs used in clinical settings and can be metabolized by cytochrome P450 isoenzyme 3A4 (CYP3A4). Voriconazole is a commonly used antifungal treatment and a CYP3A4-inhibitor. Insufficient attention to drug interactions from the concomitant use of CCB and voriconazole may result in serious adverse reactions.

CASE PRESENTATION

Here, we report a patient with acute kidney injury on stable anti-neutrophil cytoplasm antibody associated vasculitis who developed hyperkalemia resulting in sinus arrest with junctional escape rhythm attributed to drug interactions of CCB with voriconazole. This is a very rarely reported case and may be an under-recognized complication. After continuous renal replacement therapy and changing the anti-hypertensive drugs, symptoms, and laboratory abnormalities of the patient fully recovered.

CONCLUSIONS

This case warns us of severe consequences of drug interactions. Co-prescription of CYP3A4-inhibitors with calcium-channel blockers increases the risk of hypotension and acute kidney injury, which may further induce hyperkalemia and arrhythmia.

摘要

背景

患有肾脏疾病的患者可能同时患有高血压和感染。二氢吡啶钙通道阻滞剂(CCB)是临床中最常用的降压药类别,可被细胞色素 P450 同工酶 3A4(CYP3A4)代谢。伏立康唑是一种常用的抗真菌治疗药物,也是 CYP3A4 的抑制剂。由于同时使用 CCB 和伏立康唑可能导致严重的不良反应,因此对药物相互作用的关注不足。

病例介绍

这里,我们报告了一例稳定的抗中性粒细胞胞质抗体相关性血管炎患者发生急性肾损伤,出现高钾血症导致窦性停搏伴交界性逸搏节律,这归因于 CCB 与伏立康唑的药物相互作用。这是一个非常罕见的病例,可能是一种未被认识的并发症。经过连续肾脏替代治疗和更换降压药物后,患者的症状和实验室异常完全恢复。

结论

这个病例警告我们药物相互作用可能会产生严重后果。CYP3A4 抑制剂与钙通道阻滞剂的联合处方会增加低血压和急性肾损伤的风险,这可能进一步导致高钾血症和心律失常。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fc40/8111715/0925c1167a0c/12882_2021_2370_Fig1_HTML.jpg

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