索凡替尼片和羟考酮缓释片致深度昏迷和重度药源性肝损伤1例分析  

One case of deep coma and severe drug-induced liver injury caused by sulfatinib and oxycodone hydrochloride prolonged-release tablets

作　　者：陈刚[1] 李岩 姜彩虹[2] 解沛涛 苏长海[1] CHEN Gang;LI Yan;JIANG Caihong;XIE Peitao;SU Changhai(Department of Pharmacy,Ordos Central Hospital,Ordos Inner Mongolia 017000,China;Department of Medical Oncology,Ordos Central Hospital,Ordos Inner Mongolia 017000,China)

机构地区：[1]鄂尔多斯市中心医院药剂科,内蒙古鄂尔多斯017000 [2]鄂尔多斯市中心医院肿瘤内科,内蒙古鄂尔多斯017000

出　　处：《中国药物警戒》2023年第11期1296-1298,1302,共4页Chinese Journal of Pharmacovigilance

基　　金：鄂尔多斯市医学重点学科建设资助项目(鄂卫健发[2020]230号)。

摘　　要：目的 分析服用索凡替尼和羟考酮缓释片后导致深度昏迷和重度药源性肝损伤的病例,为临床安全使用提供参考。方法 对1例服用索凡替尼和羟考酮缓释片导致的深度昏迷和重度药源性肝损伤的小细胞肺癌患者进行描述,报告治疗过程,并回顾相关文献。结果 本例男性小细胞肺癌患者,因骨转移疼痛长期规律服用羟考酮缓释片治疗,在给予索凡替尼口服治疗4 d后,患者出现深度昏迷,考虑羟考酮中毒,给予纳洛酮解救后好转。同时急查肝功能指标,转氨酶升高超过5倍上限值,考虑药源性肝损伤,立即停用索凡替尼并给予对症保肝处理,1周后转氨酶恢复正常水平。再次在羟考酮缓释片基础上联合索凡替尼,再次出现转氨酶伴胆红素升高。索凡替尼和羟考酮诱导的深度昏迷的Naranjo评分为7分(很可能)。2种药物相互作用相关的文献少有报道。结论 医师和药师应重视药物治疗中的相互作用,特别是存在肝药酶体系相互作用的药物。对于癌痛患者中阿片耐受者,在联用潜在相互作用的药物时,要提高警惕,加强监护。Objective To analyze one case of deep coma and severe liver injury induced by sulfatinib and oxycodone sustained-release tablets so as to provide reference for safe use.Methods The clinical data of one patient with deep coma and severe liver injury caused by sulfatinib and oxycodone sustained-release tablets was described,the treatment process was reported,and the related literature was reviewed.Results This male patient with small cell lung cancer regularly took oxycodone sustained-release tablets chronically due to bone metastasis.After 4 days of oral treatment with sulfatinib,the patient developed deep coma,which was considered to be oxycodone poisoning.His symptoms were improved after naloxone was administered.His liver function index was checked soon.It was found that the level of transaminase had increased more than five times the upper limit.Drug-induced liver injury was regarded as likely so that sulfatinib was immediately discontinued,followed by symptomatic hepatoprotective treatment,and transaminase returned to normal one week later.Sulfatinib was used a second time in combination with oxycodone sustained-release tablets before transaminases and bilirubin increased again.The Naranjo score for sulfatinib and oxycodone-induced deep coma was 7(most likely).The interactions between the two drugs were little reported.Conclusion Physicians and pharmacists should pay attention to drug interactions during medication,especially interactions between the liver,drug and enzyme system.For opioid tolerant patients with cancer pain,vigilance and monitoring must be strengthened when potentially interacting drugs are used in combination.

关 键 词：索凡替尼 羟考酮 昏迷 药物性肝损伤 小细胞肺癌 药品不良反应 

分 类 号：R979.1[医药卫生—药品] R994[医药卫生—药学]