1例奈玛特韦/利托那韦联合利伐沙班和胺碘酮致肝损伤及心动过缓的病例分析

A case analysis of liver injury and bradycardia induced by nirmatrelvir/ritonavir tablets combined with rivaroxaban and amiodarone

目的 本文对1例奈玛特韦/利托那韦片(Nirmatrelvirl/ritonavir tablets, Paxlovid)联合利伐沙班和胺碘酮导致新型冠状病毒感染(COVID-19)患者发生凝血酶原时间(PT)值延长、严重心动过缓及转氨酶升高的病例进行分析。方法 临床药师结合患者各项检查及诊疗经过,明确不良反应发生与药物的相关性,并对Paxlovid与利伐沙班和胺碘酮的相互作用进行分析,为后续治疗提供合理用药建议。结果 通过临床药师的干预,及时解决了该患者因药物相互作用产生的不良反应,患者转氨酶、心率明显好转,COVID-19症状改善,核酸检测阴性出院。结论 Paxlovid是CYP3A4的抑制剂,可升高由CYP3A4代谢的药物利伐沙班和胺碘酮的血浆浓度,从而发生不良反应。建议新冠患者使用Paxlovid时,避免同时使用利伐沙班和胺碘酮,必须使用时,要监测血药浓度。

Objective To analyze a case of COVID-19 patient with adverse reactions such as prolonged prothrombin time(PT),severe bradycardia and elevated transaminase caused by nirmatrelvir/ritonavir tablets(Paxlovid)combined with rivaroxaban and amiodarone.Methods Clinical pharmacists clarified the correlation between the occurrence of adverse reactions and drugs by combining various examinations and diagnosis and treatment of patients,and analyzed the interaction between paxlovid,rivarxaban and amiodarone,providing reasonable drug recommendations for the following treatment.Results Through the intervention of clinical pharmacists,the adverse reactions caused by drug interaction were solved in time.The patient′s transaminase and heart rate were improved significantly,COVID-19 symptoms were improved,and the nucleic acid test was negative,so the patient was discharged.Conclusion Paxlovid is an inhibitor of CYP3A,which can increase the plasma concentration of drugs metabolized by CYP3A,such as rivaroxaban and amiodarone,leading to adverse reactions.Patients with COVID-19 are advised to avoid using both rivaroxaban and amiodarone when use paxlovid,and the blood concentrations should be monitored if necessary.