由于多种药物相互作用:氯氮平毒性报告。

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Cadeddu G, Deidda Stochino我,Velluti N, Burrai C,德尔Zompo M

由于多种药物相互作用:氯氮平毒性报告。

J地中海众议员2015 4月2;9:77。doi: 10.1186 / s13256 - 015 - 0547 - 2。

PubMed ID

25890012 (在PubMed

]

文摘

简介:我们报告的情况下多个涉及氯氮平的药物相互作用,抗真菌和口服避孕药,导致增加氯氮平等离子体水平,心包炎心包积液和嗜酸性粒细胞在一个年轻的白人女性。这些症状和体征消失几天后停用氯氮平。目前,我们没有意识到的报道clozapine-antifungals交互,而只有一个其他病例报告在口服避孕药之间的交互和氯氮平。本病例报告的目的是显示潜在的严重副作用的风险源于药物相互作用涉及药物通常用于临床实践。案例介绍:29岁的白人妇女诊断出患有分裂情感性障碍急性精神病被送进精神病单位(幻觉、妄想和紧张性精神症的行为)。她否认吸烟烟草制品,长期口服避孕药。第一个月期间住院她接受抗精神病药物和1星期了同时氟康唑和咪康唑凝胶,在被诊断为口腔念珠菌病。最后一天的抗真菌治疗,入院后29天,氯氮平是精神病症状开始解决。3周后,她的氯氮平等离子体水平增加到542 ng / mL和嗜酸性粒细胞被观察到。她抱怨恶心、呕吐和心悸; echocardiography showed echocardiographic abnormalities and pericardial effusion. Oral contraceptives were discontinued and after 1 week clozapine was interrupted, with a complete resolution of side effects and pericardial effusion within 4 days. CONCLUSIONS: Clozapine is metabolized by cytochrome P450. The use of inhibitors or other substrates of cytochrome P450, such as antifungals and oral contraceptives, can cause long-lasting interactions and clozapine toxicity. The Naranjo algorithm shows clozapine is a definite cause of pericarditis (score 9) and both clozapine-antifungals and clozapine-contraceptives interactions resulted probable (score 5) in Drug Interaction Probability Scale. A good knowledge on drugs that act as substrates, inhibitors or inducers of cytochrome P450 is mandatory. When those drugs are used in patients taking clozapine, blood level monitoring of clozapine should be recommended, since a lower dose of clozapine might be required to prevent clozapine toxicity.

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药物

屈

药物酶

药物	酶	类	生物	药理作用	行动
屈	细胞色素P450 3 a4	蛋白质	人类	未知的	底物	细节