Rapaić Aleksandra, Milošević Ekaterina, Todorović Nemanja, Janjić Nataša, Lalić-Popović Mladena, Milošević Nataša
AU Biofarm, 21000 Novi Sad, Serbia.
Department of Pharmacy, Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia.
Reports (MDPI). 2024 Feb 8;7(1):11. doi: 10.3390/reports7010011.
The modern concept of pharmaceutical healthcare implies monitoring the pharmacotherapy outcomes and reporting adverse drug reactions.
To present a suspected hematuria as the adverse rivaroxaban reaction in a patient with atrial fibrillation observed by pharmacists in a community pharmacy.
A 69-year-old female patient came to a pharmacy with a prescription for cranberry-based supplement. She was diagnosed with a mild urinary infection after experiencing blood in her urine for about two weeks. The pharmaceutical anamnesis revealed that the patient was treated with irbesartan and rivaroxaban. Rivaroxaban was applied for atrial fibrillation, and the patient was treated for nine months. The patient was treated with omeprazole gastro-resistant capsules for mild dyspepsia and stomach ache over a three-week period. The pharmacist counselled the patient to contact the clinician who introduced rivaroxaban, further suggesting substitution with different anticoagulant. Although the urine culture was negative, the physician introduced ciprofloxacin, which was followed by blood in the patient's stool. Thus, gastroscopy, colonoscopy, and gynecological examination were advised. All findings were normal. Four days after rivaroxaban was substituted with acenocoumarol, no blood in the urine or stool was detected.
Rivaroxaban can cause spot urine blood even when applied in therapeutic doses among older female patients when applied with omeprazole. Possible rivaroxaban interaction with omeprazole metabolites is suspected and should be carefully monitored.
现代药物治疗保健理念意味着监测药物治疗效果并报告药物不良反应。
介绍社区药房药师观察到的1例心房颤动患者使用利伐沙班后出现疑似血尿的药物不良反应。
一名69岁女性患者持蔓越莓补充剂处方来到药房。她在出现血尿约两周后被诊断为轻度尿路感染。用药史显示该患者正在接受厄贝沙坦和利伐沙班治疗。利伐沙班用于治疗心房颤动，患者已接受治疗9个月。患者因轻度消化不良和胃痛服用耐酸奥美拉唑胶囊3周。药师建议患者联系开具利伐沙班的临床医生，并进一步建议换用其他抗凝剂。尽管尿培养结果为阴性，但医生仍开具了环丙沙星，随后患者出现便血。因此，建议进行胃镜、结肠镜和妇科检查。所有检查结果均正常。利伐沙班换用醋硝香豆素4天后，未再检测到血尿或便血。
在老年女性患者中，利伐沙班与奥美拉唑联用时，即使使用治疗剂量也可能导致镜下血尿。怀疑利伐沙班与奥美拉唑代谢产物之间可能存在相互作用，应予以密切监测。
