Cadle R M, Zenon G J, Rodriguez-Barradas M C, Hamill R J
Department of Veterans Affairs Medical Center (VAMC), Pharmacy Service, Houston, TX 77030.
Ann Pharmacother. 1994 Feb;28(2):191-5. doi: 10.1177/106002809402800206.
To report two cases of fluconazole-induced symptomatic phenytoin toxicity and review literature related to this interaction.
Case reports and review articles identified by a computerized (MEDLINE) and manual (Index Medicus) search.
Fluconazole is a broad-spectrum triazole antifungal agent primarily eliminated by renal mechanisms, although hepatic cytochrome P-450 inhibition and hepatotoxicity have been observed. We report two cases of fluconazole-induced symptomatic phenytoin toxicity. Both patients received high doses of the drug; one patient developed phenytoin toxicity only after long-term coadministration. Previously reported cases have occurred primarily with high-dose fluconazole and short-term coadministration.
Fluconazole can increase phenytoin serum concentrations leading to toxicity. Constant and continuous monitoring of serum phenytoin concentrations with fluconazole doses as low as 200 mg/d is warranted.
报告两例氟康唑诱发的有症状的苯妥英钠中毒病例，并回顾与此相互作用相关的文献。
通过计算机检索（MEDLINE）和手工检索（医学索引）确定的病例报告和综述文章。
氟康唑是一种广谱三唑类抗真菌药，主要通过肾脏机制消除，尽管已观察到其对肝细胞色素P-450的抑制作用和肝毒性。我们报告两例氟康唑诱发的有症状的苯妥英钠中毒病例。两名患者均接受了高剂量该药治疗；一名患者仅在长期联合用药后才出现苯妥英钠中毒。先前报道的病例主要发生在高剂量氟康唑和短期联合用药的情况下。
氟康唑可使苯妥英钠血清浓度升高，导致中毒。即使氟康唑剂量低至200mg/d，也有必要持续不断地监测血清苯妥英钠浓度。
