2014—2023年首都医科大学附属北京安定医院喹硫平致心血管系统不良反应分析

Adverse reactions of cardiovascular system induced by quetiapine in Beijing Anding Hospital Affiliated to Capital Medical University from 2014 to 2023

目的调查分析首都医科大学附属北京安定医院喹硫平导致心血管系统药品不良反应的特点。方法选取2014—2023年首都医科大学附属北京安定医院上报国家不良反应中心的121例喹硫平致心血管系统不良反应的病例,分析患者的不良反应及药物治疗情况,治疗措施及转归等方面,探讨喹硫平导致心血管系统不良反应的临床特点。结果121例患者中,女性占比(61.98%)较大。原患疾病以双相情感障碍为主,为51例(42.15%)。发生不良反应时,用药剂量均较低,仅12例患者剂量超过700mg/d。不良反应以直立性低血压为主(42.98%)。不良反应多发生在用药初期,大部分在用药10d内出现症状。不良反应的临床表现方面,直立性低血压患者收缩压和舒张压呈不同程度的降低。患者出现不良反应后,及时处理并密切观察不良反应情况,症状均缓解或恢复正常。结论喹硫平在较小日剂量使用时,仍有导致心血管不良反应的风险。喹硫平还可引起罕见的不良反应,包括心悸、高血压、QT间期延长、心动过缓等。其中QT间期延长是较为严重的不良反应,可能导致更严重的不良反应发生,如心源性猝死。对于存在先天性长QT综合征、心衰、女性、老年等危险因素时,使用喹硫平期间务必做好全面检查,在药物治疗初期,应进行电解质和心电图监护等,避免更严重的不良反应发生。

Objective To investigate and analyze the characteristics of adverse drug reactions in cardiovascular system caused by quetiapine in Beijing Anding Hospital Affiliated to Capital Medical University.Methods 121 Cases of adverse cardiovascular reactions caused by quetiapine reported to the National Adverse Reaction Center in Beijing Anding Hospital Affiliated to Capital Medical University from 2014 to 2023 were selected and analyzed.Adverse reactions,drug treatment,treatment measures and outcomes of patients were analyzed in detail,and the clinical characteristics of adverse cardiovascular reactions caused by quetiapine were discussed.Results Among the 121 patients,women accounted for a large proportion(61.98%).The primary disease was bipolar disorder,51 cases(42.15%).When adverse reactions occurred,the dosage was low,and only 12 patients had a dose of more than 700 mg/d.Orthostatic hypotension accounted for a large proportion(42.98%).Most of the adverse reactions occurred in the early stage of medication,and most of the adverse reactions appeared within 10 d of medication.In terms of clinical manifestations of adverse reactions,systolic and diastolic blood pressure were reduced in patients with orthostatic hypotension to varying degrees.After adverse reactions occurred,patients were treated in time and adverse reactions conditions were closely observed,and symptoms were relieved or returned to normal.Conclusions Quetiapine is still at risk of cardiovascular adverse events at smaller daily doses.Quetiapine can also cause rare adverse reactions,including palpitations,hypertension,QT interval prolongation,bradycardia,etc.QT interval prolongation is a more serious adverse reaction,which may lead to more serious adverse reactions,such as sudden cardiac death.For the presence of congenital long QT syndrome,heart failure,female,elderly and other risk factors,it is necessary to do a comprehensive examination during the use of quetiapine,in the early stage of drug treatment,electrolyte and electrocardiogram monitoring should be carried out to avoid more serious adverse reactions.