舍曲林致肝损伤  

Sertraline-induced liver injury

作　　者：梁海霞[1] 孟繁强[2] 李鹏[2] 凌四海 果伟[1] Liang Haixia;Meng Fanqiang;Li Peng;Ling Sihai;Guo Wei(Department of Pharmacy, Beijing Anding Hospital, Capital Medical University, Beijing 100088, China;Department of Geriatric Psychiatry, Beijing A riding Hospital, Capital Medical University, Beijing 100088, China;Clinical Laboratory and Experimental Center, Beijing A ruling Hospital, Capital Medical University, Beijing 100088, China)

机构地区：[1]首都医科大学附属北京安定医院药事部,100088 [2]首都医科大学附属北京安定医院老年精神科,100088 [3]首都医科大学附属北京安定医院临床检验与实验中心,100088

出　　处：《药物不良反应杂志》2019年第2期146-147,共2页Adverse Drug Reactions Journal

摘　　要：1例66岁女性患者因复发性抑郁障碍、睡眠障碍、高血压,遵医嘱口服舍曲林(初始剂量25 mg、1次/d,逐渐增加剂量,第10天至100 mg、1次/d)、佐匹克隆(7.5 mg、每晚1次)、劳拉西泮(0.5 mg、3次/d)和氨氯地平(2.5 mg、1次/d)治疗。用药前,患者血清天冬氨酸转氨酶(AST)21 U/L、丙氨酸转氨酶(ALT)16 U/L、γ-谷氨酰转肽酶(γ-GT)50 U/L。用药第16天,患者血清AST 114 U/L、ALT 134 U/L、γ-GT 192 U/L,未调整治疗方案;用药第21天,血清AST 178 U/L、ALT 242 U/L、γ-GT 362 U/L。给予保肝药物治疗,舍曲林逐渐减量至停用(减量至25 mg、1次/d时加用艾司西酞普兰5 mg口服、1次/d,但用药期间患者诉腿部不适,最终将艾司西酞普兰换为米氮平15 mg、每晚睡前口服),其他药物继续服用。患者肝功能逐渐好转,停用舍曲林约50 d后,患者血清AST 35 U/L、ALT36 U/L、γ-GT 108 U/L。A 66-year-old female patient received oral sertraline (initial dose 25 mg once daily, gradually increased to 100 mg once daily on day 10), zopiclone (7.5 mg once per night), lorazepam (0.5 mg thrice daily), and amlodipine (2.5 mg once daily) following the doctor′s advice due to recurrent depressive disorder, sleep disorder, and hypertension. Before administration, the patient′s serum levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and γ-glutamyl transpeptidase (γ-GT) were 21 U/L, 16 U/L and 50 U/L, respectively. On day 16 after the medication, the patient′s serum levels of AST, ALT, and γ-GT were 114 U/L, 134 U/L, and 192 U/L, respectively, but the treatment protocol was not adjusted. On day 21 after the medication, her serum levels of AST, ALT, and γ-GT turned to be 178 U/L, 242 U/L, and 362 U/L, respectively. Then hepatoprotective drugs were given, sertraline was discontinued by gradual reduction (oral escitalopram 5 mg once daily was added when sertraline was reduced to 25 mg once daily, but escitalopram was changed to oral mirtazapine 15 mg at bedtime finally due to the patient′s leg discomfort), and the other drugs were continued. The liver function of the patient gradually improved and her serum levels of AST, ALT, and γ-GT were 35 U/L, 36 U/L, and 108 U/L, respectively about 50 days after sertraline withdrawal.

关 键 词：舍曲林 药物相关副作用和不良反应 肝疾病 

分 类 号：R971[医药卫生—药品]