秋水仙碱与他汀类潜在药物相互作用处方风险分析

Prescription Risk Analysis of Potential Interaction Between Colchicine and Statins

关键词:  秋水仙碱  他汀类药物  药物相互作用

Key words:  colchicine  statin  drug interaction

摘要:

目的 分析秋水仙碱与他汀类潜在药物相互作用（potential drug-drug interactions，pDDIs）处方，进行风险评估并制定预防措施。方法 检索知网、维普、万方、PubMed和Elsevier数据库关于秋水仙碱与他汀类相互作用致不良反应的个案和研究报道，进行文献分析；通过医院合理用药软件抽取2020年1月—2022年10月秋水仙碱联合他汀类药物的所有门诊处方，鉴别出潜在药物相互作用并进行严重性分级。结果 检索到该药物相互作用致不良反应个案报道22例，病例对照研究1篇，观察性队列研究2篇；不良反应以老年人居多，男性多于女性；发生时间集中在联合用药21 d内，3例患者死亡；高剂量、高龄、男性和肝/肾功能不全可能增加该pDDIs发生风险；遵义医科大学附属医院共收集到秋水仙碱联合他汀类药物处方72张，其中阿托伐他汀65张，瑞舒伐他汀6张，辛伐他汀1张，危险程度分级均为严重；1例患者联合使用秋水仙碱和阿托伐他汀4个月后出现肌病，1个月后好转；临床药师制定了7项预防措施。结论 遵义医科大学附属医院秋水仙碱与他汀类处方存在pDDIs，需积极实施预防措施并加强监测，尤其是联合用药早期的老年男性及肝肾功能不全患者。

Abstract:

OBJECTIVE To analyze the prescription of potential drug-drug interactions(pDDIs) between colchicine and statins, carry out risk assessment and formulate preventive measures. METHODS The case and research reports of adverse reactions caused by the interaction between colchicine and statins were retrieved from the databases of CNKI, VIP, Wanfang, PubMed and Elsevier, and the literature was analyzed; all outpatient prescriptions of colchicine combined with statins from January 2020 to October 2022 were extracted through hospital rational drug use software to identify potential drug interactions and grade the severity. RESULTS Twenty two cases of adverse drug reactions caused by drug interaction were retrieved, including 1 case control study and 2 observational cohort studies; the majority of adverse reactions were in the elderly, male were more than female; the time of occurrence was concentrated in 21 d of combined medication, and 3 patients died; high dose, old age, male and liver/kidney dysfunction might increase the risk of this pDDIs; a total of 72 prescriptions of colchicine and statins were collected, including 65 atorvastatin prescriptions, 6 rosuvastatin prescriptions, and 1 simvastatin prescription. The risk levels were all serious; one patient developed myopathy after 4 months of colchicine combined with atorvastatin, and improved after 1 month; seven preventive measures had been formulated by clinical pharmacists. CONCLUSION There is pDDIs in colchicine and statin prescriptions in the Affiliated Hospital of Zunyi Medical University. It is necessary to actively implement preventive measures and strengthen monitoring, especially for elderly men and patients with liver/kidney dysfunction in the early stage of combined use.