Thomas A R, Chan L N, Bauman J L, Olopade C O
Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, 60612, USA.
Pharmacotherapy. 1998 Mar-Apr;18(2):381-5.
Cisapride, a cytochrome P450 3A4 (CYP3A4) substrate, is widely prescribed for the treatment of gastrointestinal motility disorders. Prolongation of QT interval, torsades de pointes, and sudden cardiac death have been reported after concomitant administration with erythromycin or azole antifungal agents, but not with other CYP3A4 inhibitors. A possible drug interaction occurred in a 45-year-old woman who was taking cisapride for gastroesophageal reflux disorder and diltiazem, an agent that has inhibitory effect on CYP3A4, for hypertension. The patient was in near syncope and had QT-interval prolongation. After discontinuing cisapride, the QT interval returned to normal and symptoms did not recur. We suggest that caution be taken when cisapride is prescribed with any potent inhibitor of CYP3A4, including diltiazem.
西沙必利是细胞色素P450 3A4（CYP3A4）的底物，被广泛用于治疗胃肠动力障碍。与红霉素或唑类抗真菌药合用时，曾有QT间期延长、尖端扭转型室速和心源性猝死的报道，但与其他CYP3A4抑制剂合用时未见此类情况。一名45岁女性因胃食管反流病服用西沙必利，因高血压服用对CYP3A4有抑制作用的地尔硫䓬，可能发生了药物相互作用。该患者出现近似晕厥，QT间期延长。停用西沙必利后，QT间期恢复正常，症状未再复发。我们建议，当西沙必利与任何强效CYP3A4抑制剂（包括地尔硫䓬）合用时应谨慎。
