1例伏立康唑药物相互作用致横纹肌溶解的案例报道并文献分析

Rhabdomyolysis caused by voriconazole drug interaction:a case report and literature analysis

目的探讨伏立康唑药物相互作用相关性肌损伤的临床特点,为该类不良反应的预防和药学监护提供参考。方法分析我院1例伏立康唑联合阿托伐他汀致横纹肌溶解的病例,同时查阅国内外相关文献并进行综述分析。结果我院1例肺曲霉菌感染合并颈动脉斑块患者使用伏立康唑联合阿托伐他汀治疗15 d后出现横纹肌溶解早期症状,最终进展为多器官衰竭。文献分析提示伏立康唑与塞来昔布、他克莫司、甲泼尼龙、奥美拉唑、埃索美拉唑、阿托伐他汀联用时发生药物相关性肌病风险增加,主要表现为肌痛、肌无力、肌酸激酶升高,严重者出现横纹肌溶解,通常于用药后12~15 d发生;有肝功能损害患者使用伏立康唑与奥美拉唑、埃索美拉唑、阿托伐他汀、阿托伐他汀联用时发生横纹肌溶解的风险更大,且大多预后不良。结论使用伏立康唑时应充分评估合并用药和患者基础状况,密切监测患者伏立康唑血药浓度、肌酶及临床表现,警惕伏立康唑药物相互作用所致横纹肌溶解的严重罕见不良反应。

Objective To investigate the clinical characteristics of voriconazole drug interaction related muscle injury,and to provide reference for the prevention and pharmaceutical care of such adverse reactions.Methods Analysis of a case of rhabdomyolysis caused by vorlikonazole combined with rosuvastatin in our hospital,while access to relevant literature review.Results A patient with pulmonary aspergillus infection complicated with carotid plaque in our hospital developed early symptoms of rhabdomyolysis after 15 days of treatment with voriconazole combined with rosuvastatin,and eventually progressed to multiple organ failure.Literature analysis suggests voriconazole with celecoxib,tacrolimus,methylprednisolone,omeprazole,esso beauty pull azole,atorvastatin drug correlation to increased risk of myopathy,main show is higher muscle pain,muscle weakness,creatine kinase,appear serious rhabdomyolysis,usually from 12 d to 15 d before and after the medication;voriconazole combined with omeprazole,esomeprazole,atorvastatin and rosuvastatin has a higher risk of rhabdomyolysis in patients with liver damage,and most of them have a poor prognosis.Conclusion Voriconazole should be used to fully evaluate the combination of drug use and the patient's basic condition,closely monitor the patient's blood drug concentration,muscle enzyme and clinical manifestations of voriconazole,and guard against the severe and rare adverse reactions of rhabdomyolysis caused by voriconazole drug interaction.