瑞舒伐他汀与替格瑞洛在横纹肌溶解风险方面的药物相互作用问题:问题讨论及临床病例描述

IF 0.3 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Rational Pharmacotherapy in Cardiology Pub Date : 2022-11-05 DOI:10.20996/1819-6446-2022-10-03
O. Gaisenok, Y. Chichkov, M. Leonova
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引用次数: 1

摘要

背景。根据急性冠状动脉综合征和冠状动脉介入治疗的临床指南,推荐联合使用两种抗血小板药物(替格瑞洛或氯吡格雷加乙酰水杨酸)和大剂量他汀类药物。联合治疗方案具有药物-药物相互作用的潜力。横纹肌溶解是他汀类药物治疗的一个已知副作用,有证据表明与替格瑞洛联合治疗会增加这种并发症的风险。案例描述。一名72岁女性患者因横纹肌溶解的典型症状住院:肌肉疼痛、少尿、虚弱、肌酸激酶(CK)、肌红蛋白和肌酐显著升高。1个月前,因急性复发性st段抬高型心肌梗死紧急住院,并行左前降支危重狭窄血管内介入治疗合并支架植入术。之后,在治疗中加入瑞舒伐他汀40 mg /天,替格瑞洛90mg /天2次。在本次住院期间,停用瑞舒伐他汀、ACE抑制剂和螺旋内酯,进行输液治疗,症状迅速消退,利尿恢复充足,CK、肌红蛋白和肌酐水平恢复正常。结论。替格瑞洛与瑞舒伐他汀联合使用(特别是在高剂量时)会增加老年患者横纹肌溶解的风险。服用替格瑞洛的患者可能需要改变他汀类药物治疗、调整剂量和可能的药物改变,以避免药物相互作用和增加副作用的风险。
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The Problem of Drug Interactions Between Rosuvastatin and Ticagrelor in the Aspect of the Risk of Rhabdomyolysis: Discussion of the Problem and Description of the Clinical Case
Background. Combination therapy with two antiplatelet agents (ticagrelor or clopidogrel plus acetylsalicylic acid) and a high dose statin is recommended in accordance with clinical guidelines for patients undergoing acute coronary syndrome and coronary intervention. Combined therapeutic regimens have drug-drug interaction potential. Rhabdomyolysis is a known side effect of statin therapy, and there is evidence that co-therapy with ticagrelor increases the risk of this complication.Case description. A 72-year-old female patient was hospitalized with typical signs of rhabdomyolysis: muscle pain, oliguria, weakness, significant increases in creatine kinase (CK), myoglobin and creatinine. One month before that, she was urgently hospitalized with acute recurrent ST-elevation myocardial infarction and underwent endovascular intervention on a critical stenosis of the left anterior descending artery with stent implantation. After that, rosuvastatin 40 mg per day and ticagrelor 90mg 2 times a day were added to her therapy. During the current hospitalization, rosuvastatin, ACE inhibitors and spirolactone were canceled, infusion therapy was carried out, which led to a rapid regression of symptoms, restoration of adequate diuresis, and normalization of CK, myoglobin and creatinine levels. Conclusions. The combined use of ticagrelor with rosuvastatin (especially at a high dose) increases the risk of rhabdomyolysis in elderly patients. Patients taking ticagrelor may require changes in statin therapy, dose adjustments, and possible drug changes to avoid pharmacological interactions and an increased risk of side effects.
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来源期刊
Rational Pharmacotherapy in Cardiology
Rational Pharmacotherapy in Cardiology CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
1.00
自引率
50.00%
发文量
79
审稿时长
6 weeks
期刊介绍: The primary goals of the Journal are consolidation of information on scientific and practical achievements in pharmacotherapy and prevention of cardiovascular diseases and continuing education of cardiologists and internists. The scientific concept of the edition suggests the publication of information on current achievements in cardiology, the results of national and international clinical trials. The Journal publishes original articles on the results of clinical trials designed to study the effectiveness and safety of drugs, analysis of clinical practice and its compliance with national and international recommendations, expert s’ opinions on a wide range of cardiology issues, associated conditions and clinical pharmacology. There is a heading “Preventive cardiology and public health” in the Journal to stimulate research interest in this highly demanded area. Memories of the outstanding people in medicine including cardiology, which are of great interest to historians of medicine, are published in "Our Mentors” heading.
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