因药物相互作用引起横纹肌溶解1例报告

A case report on the rhabdomyolysis caused by the interaction of simvastatin

对入院后的1例冠心病合并糖尿病、高脂血症和抑郁症的77岁女性患者给予抗血小板、降血压、调脂、降血糖和抗抑郁治疗。7 d后患者出现臀部等全身多处肌肉疼痛,肌酸激酶水平为1 757 U/L,肌酸激酶同功酶MM水平为1 739 U/L。该患者在5年前接受冠状动脉造影术后曾长期服用辛伐他汀,没有发生过任何不良反应,但此次住院后服用小剂量辛伐他汀却出现了横纹肌溶解,若将其肌酸激酶水平升高归因为辛伐他汀引起的不良反应比较勉强。药师发现患者在此次住院前1周开始服用氟西汀和富马酸喹硫平治疗抑郁症,而此两药均会抑制辛伐他汀的代谢,导致辛伐他汀血药浓度升高,增加辛伐他汀不良反应的发生几率。因此,药师建议先停用辛伐他汀,待患者肌酸激酶水平恢复正常后再换用不经细胞色素P450 3A4酶代谢的瑞舒伐他汀。患者换用瑞舒伐他汀后30 d门诊就诊,结果见其肌痛症状消失,肌酸激酶水平也正常。

A 77 years old woman was treated with antiplatelet, antihypertensive, lipid lowering, hypoglycemic and antidepressant drugs after she was hospitalized with coronary heart disease, diabetes, hyperlipidemia and depression. Seven days after admission, multiple muscle pain such as hip pain and so on occurred in the patient. The levels of creatine kinase and creatine kinase MM were 1 757 U/L and 1 739 U/L which was considered as rhabdomyolysis caused by simvastatin. The patient has been taking simvastatin for 5 years after coronary angiography but there was no any adverse drug reaction occurred. However, rhabdomyolysis occurred this time after taking only small doses of simvastatin. The pharmacist noticed that the patient had taken fluoxetine and quetiapine for the treatment of depression for one week before admission, which could result in the rhabdomyolysis caused by the inhibition of the metabolism of simvastatin and the increase of both the concentration of simvastatin serum and the risk of adverse reactions. Pharmacist suggested that the patient stopped taking simvastatin first and then rosuvastatin would be taken after creatine kinase level in the patient was recovered to normal because rosuvastatin is not metabolized bye cytochrome enzyme 3A4. Fibromyalgia symptoms disappeared and creatine kinase level was also recovered to normal 30 days after switching to rosuvastatin.