Chitwood K K, Abdul-Haqq A J, Heim-Duthoy K L
Drug Evaluation Unit, Hennepin County Medical Center, Minneapolis.
Ann Pharmacother. 1993 May;27(5):569-71. doi: 10.1177/106002809302700506.
To report a possible interaction between cyclosporine (CsA) and amiodarone in a kidney transplant recipient.
A 66-year-old kidney transplant recipient with a history significant for hypertension, moderate mitral valve insufficiency, and decreased left ventricular function developed ventricular tachycardia posttransplant and was eventually treated with amiodarone. Maintenance immunosuppression included prednisone, azathioprine, and CsA. CsA concentrations before amiodarone initiation were stable (range 100-150 ng/mL). After amiodarone initiation, the CsA concentration increased more than twofold. Following CsA dosage reduction, concentrations returned to the desired range. The patient did not experience any toxicity with the increased concentration of CsA.
The possible mechanisms of an interaction between CsA and amiodarone are reviewed. Reports of this interaction in heart transplant recipients are also reviewed. Changes in protein binding, changes in metabolism, or both may explain the interaction. Both CsA and amiodarone are protein bound and metabolized by the cytochrome P-450 enzyme system.
It is likely that there is an interaction between CsA and amiodarone. The exact mechanism of this interaction has not been fully determined. When CsA is administered concurrently with amiodarone, CsA concentrations should be monitored closely and the CsA dosage should be adjusted as necessary.
报告1例肾移植受者中环孢素（CsA）与胺碘酮之间可能存在的相互作用。
1例66岁肾移植受者，有高血压、中度二尖瓣关闭不全及左心室功能减退病史，移植后发生室性心动过速，最终接受胺碘酮治疗。维持性免疫抑制治疗包括泼尼松、硫唑嘌呤和CsA。开始使用胺碘酮前CsA浓度稳定（范围为100 - 150 ng/mL）。开始使用胺碘酮后，CsA浓度增加了两倍多。减少CsA剂量后，浓度恢复到理想范围。患者未出现CsA浓度升高导致的任何毒性反应。
综述了CsA与胺碘酮之间相互作用的可能机制。还综述了心脏移植受者中这种相互作用的报道。蛋白结合的变化、代谢的变化或两者都可能解释这种相互作用。CsA和胺碘酮均与蛋白结合并通过细胞色素P - 450酶系统代谢。
CsA与胺碘酮之间可能存在相互作用。这种相互作用的确切机制尚未完全确定。当CsA与胺碘酮同时使用时，应密切监测CsA浓度，并根据需要调整CsA剂量。
