临床药师对1例瑞巴派特致Stevens-Johnson综合征的药学分析

Pharmaceutical analysis for a patient with rebamipide-induced Stevens-Johnson syndrome by clinical pharmacists

目的为瑞巴派特致Stevens-Johnson综合征的诊治提供参考,并探讨患者发生Stevens-Johnson综合征的易感因素。方法临床药师整理分析1例胃肠疾病患者的治疗过程,评价该患者所用药物与不良反应的关联性,以判断引起Stevens-Johnson综合征的可疑致敏药物;同时探讨患者发生Stevens-Johnson综合征的易感因素。结果与结论引起该患者发生Stevens-Johnson综合征的可疑致敏药物包括艾普拉唑肠溶片、瑞巴派特片、康复新液。根据国家药品不良反应监测中心因果关系评价方法、诺氏评估量表、表皮坏死松解症的药物因果关系算法(ALDEN)评分标准,综合判断引起Stevens-Johnson综合征的可疑致敏药物为瑞巴派特。低蛋白状态、药物之间竞争性结合血浆蛋白、高龄、细菌合并病毒感染可能是该患者发生Stevens-Johnson综合征的易感因素。因此临床在使用瑞巴派特前,应详细询问患者过敏史,在使用过程中应加强对患者的用药监护,警惕严重的不良反应的发生,如发现异常应立即停药并及时给予对症处理,以保障患者用药的安全性和有效性。

OBJECTIVE To provide reference for the diagnosis and treatment of Stevens-Johnson syndrome caused by rebamipide,and to explore the predisposing factors of Stevens-Johnson syndrome.METHODS Clinical pharmacists analyzed the treatment process of a patient with gastrointestinal diseases and evaluated the correlation between the drug used and adverse reactions,in order to determine the suspected allergenic drug causing Stevens-Johnson syndrome.The predisposing factors of patients with Stevens-Johnson syndrome were explored.RESULTS&CONCLUSIONS The suspected allergenic drugs that caused the patient to develop Stevens-Johnson syndrome included Ilaprazole enteric-coated tablets,Rebamipide tablets and Kangfuxin liquid.In summary,the suspect drug was identified as Rebamipide tablets according to the causality evaluation method of the National Center for Adverse Drug Reaction Monitoring,Naranjo’s scoring method and the algorithm of drug causality for epidermal necrolysis scoring criteria.Hypoproteinemia,competitive binding of plasma proteins between drugs,advanced age,bacterial and viral infections were the predisposing factors of Stevens-Johnson syndrome.Therefore,before using rebamipide in clinical practice,it is necessary to inquire about the patient’s allergy history in detail.During the use process,it is necessary to strengthen the patient’s medication monitoring and be alert to the occurrence of serious adverse reactions.If any abnormalities are found,the medication should be stopped immediately and symptomatic treatment should be given as soon as possible to ensure the safety and effectiveness of the patient’s medication.