伏立康唑联合依伐布雷定致严重心动过缓1例  

Severe bradycardia caused by the combined use of voriconazole and ivabradine

作　　者：李蓓华 王岩[2] 王海涛[2] Bei-Hua LI;Yan WANG;Hai-Tao WANG(Department of Pharmacy,Shaanxi Traffic Hospital,Xi’an 710000,China;Department of Pharmacy,The Second Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710004,China)

机构地区：[1]陕西省交通医院药械科,西安710000 [2]西安交通大学第二附属医院药学部,西安710004

出　　处：《药物流行病学杂志》2023年第12期1436-1440,共5页Chinese Journal of Pharmacoepidemiology

摘　　要：1例15岁女性狼疮性肾炎伴心衰患者,长期使用美托洛尔和依伐布雷定治疗,入院后心率保持在65~70次/min。入院第14天合并肺曲霉菌感染,加用伏立康唑抗真菌治疗3 d后发生严重心动过缓,心率降至45次/min。临床药师结合患者的联合用药史及药物代谢动力学特征,采用Naranjo’s评估量表和药物相互作用可能性量表进行评估,判断该不良反应是因伏立康唑与依伐布雷定发生药物相互作用所致,建议继续伏立康唑抗真菌治疗,停用依伐布雷。医师采纳该建议,1 d后患者心率恢复至65次/min。临床药师及时识别并干预药物相互作用诱发的不良反应,促进了临床合理用药,保障了患者的用药安全。A 15-year-old female patient with lupus nephritis and heart failure,who had been on long-term treatment with metoprolol and ivabradine,maintained a heart rate of 65-70 beats per minute after admission.On the 14th day of admission,the patient developed a pulmonary aspergillus infection,and after 3 days of adding voriconazole antifungal treatment,the patient experienced severe bradycardia,with her heart rate dropping to 45 beats per minute.The clinical pharmacist,in combination with the patient's combined medication history and pharmacokinetic characteristics,used Naranjo's assessment scale and DIPS score to determine that the adverse reaction was due to the drug interaction between voriconazole and ivabradine,and suggested to continue voriconazole antifungal treatment and discontinue ivabradine.The doctor accepted this suggestion,and the patient's heart rate returned to 65 beats per minute the next day.The clinical pharmacist timely identified and intervened in the adverse reaction induced by the drug interactions,which promoted rational clinical medication and ensured the patient's medication safety.

关 键 词：伏立康唑 依伐布雷定 心动过缓 药物相互作用 药品不良反应 

分 类 号：R969[医药卫生—药理学]