Fournier P, Pacouret G, Charbonnier B
Service de Cardiologie D, CHRU de Tours, Hôpital Trousseau.
Ann Cardiol Angeiol (Paris). 1993 May;42(5):249-52.
The authors report a case of wave-burst arrhythmia which occurred during combined treatment with terfenadine and troleandomycin. After the treatment had been stopped and the QT interval returned to normal, terfenadine treatment was reintroduced with no major change in repolarization. However, as soon as troleandomycin was associated, there was a significant and progressive prolongation of QT. Normal repolarization was restored again with troleandomycin alone. These findings suggest drug interaction between terfenadine and troleandomycin. Although it is not possible to carry out serum assays of terfenadine, one possible physiopathological hypothesis would be an overdose of terfenadine. Terfenadine undergoes hepatic oxidative metabolism involving the cytochrome P450 pathway and troleandomycin inhibits cytochrome P450. In the literature, a case has already been described of wave-burst arrhythmia related to terfenadine overdose when associated with a cytochrome P450 inhibitor.
作者报告了1例在特非那定与醋竹桃霉素联合治疗期间发生的波群性心律失常。在停药且QT间期恢复正常后，重新使用特非那定治疗，复极化无重大变化。然而，一旦联合使用醋竹桃霉素，QT就会显著且逐渐延长。单独使用醋竹桃霉素时复极化又恢复正常。这些发现提示特非那定与醋竹桃霉素之间存在药物相互作用。虽然无法进行特非那定的血清检测，但一种可能的生理病理假说可能是特非那定过量。特非那定经涉及细胞色素P450途径的肝脏氧化代谢，而醋竹桃霉素抑制细胞色素P450。文献中已有1例与细胞色素P450抑制剂联合使用时因特非那定过量导致波群性心律失常的病例报道。
