1例急性心肌梗死合并小肠间质瘤患者的药物治疗方案调整

Adjustment of therapeutic regimen for an acute myocardial infarction patient with small intestinal stromal tumor

1例60岁男性患者,因急性ST段抬高型心肌梗死入院。患者因小肠恶性间质瘤病史7年,口服伊马替尼进行治疗。伊马替尼经细胞色素P450酶系代谢,可竞争性抑制CYP3A4、CYP2D6、CYP2C9、CYP2C19等活性,同时还是转运蛋白P-gp的底物和抑制剂,与多种急性心肌梗死常用治疗药物存在相互作用。临床药师建议将与伊马替尼存在相互作用的阿托伐他汀和依那普利分别替换为瑞舒伐他汀和雷米普利,并将氯吡格雷替换为替格瑞洛,同时对患者进行药学监护和用药指导。经对症治疗,患者病情好转出院。

A 60-year-old male patient with acute ST-segment elevation myocardial infarction was admitted to hospital. This patient received imatinib orally because of small intestinal stromal tumor for 7 years. Imatinib is metabolized by the cytochrome P450 and transport protein P-glycoprotein, and imatinib can inhibit the activity of CYP3A4, CYP2D6, CYP2C9, CYP2C19 and P-glycoprotein. So imatinib has the potential interaction with many drugs used for the treatment of acute myocardial infarction. Pharmacists suggested replacing atorvastatin to rosuvastatin, enalapril to ramipril, and clopidogrel to ticagrelor for avoiding potential drug interaction, respectively. At the same time, pharmacists provided pharmaceutical care and medication guide to the patient. After symptomatic treatment, the patient was discharged with a better health condition.