环孢素联合用药致高钾血症1例及文献分析

doi:10.19803/j.1672-8629.2021.12.21

中国药物警戒 ›› 2021, Vol. 18 ›› Issue (12): 1192-1195.
DOI: 10.19803/j.1672-8629.2021.12.21

环孢素联合用药致高钾血症1例及文献分析

杨晓雯^1,2, 王晓星^1,*

¹中日友好医院药学部,北京 100029;
²内蒙古医科大学附属医院药剂部,内蒙古呼和浩特 010050

收稿日期:2020-02-24 出版日期:2021-12-15 发布日期:2021-12-16
通讯作者: ^*王晓星,女,博士,主管药师,临床药学免疫。E-mail：xxshining@163.com
作者简介:杨晓雯,女,硕士,药师,临床药学。
基金资助:
国家自然科学基金青年科学基金项目（81402942）

One Case of Hyperkalemia Induced by Concomitant Use of Cyclosporine and Other Drugs

YANG Xiaowen^1,2, WANG Xiaoxing^1,*

¹Department of Pharmacy, China-Japan Friendship Hospital, Beijing 100029, China;
²Department of Pharmacy, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot Inner Mongolia 010050, China

Received:2020-02-24 Online:2021-12-15 Published:2021-12-16

摘要/Abstract

摘要： 目的探讨环孢素联合用药致高钾血症的发生机制和临床特点。方法分析1例应用环孢素联合伏立康唑、沙库巴曲缬沙坦治疗狼疮性肾炎致患者高钾血症的诊疗经过,通过文献分析,探讨上述药物联合使用导致血钾升高可能的机制及处理措施。结果患者联合使用环孢素、沙库巴曲缬沙坦、伏立康唑5 d后出现血钾升高,停用环孢素、沙库巴曲缬沙坦后,5 d内血钾仍未恢复正常,直至停用伏立康唑后血钾完全恢复正常。而再次加用伏立康唑时血钾水平无异常。提示患者联合使用环孢素、伏立康唑、沙库巴曲缬沙坦增加了环孢素发生高血钾不良反应的风险。结论联合使用环孢素、伏立康唑以及作用于肾素-血管紧张素-醛固酮系统的药物时,即使环孢素在相对较低的血药浓度范围内,仍需警惕高钾血症的发生。

关键词: 环孢素, 伏立康唑, 系统性红斑狼疮, 高血钾, 药物相互作用

Abstract: Objective To explore the mechanism and clinical features of hyperkalemia induced by concomitant use of cyclosporine and other drugs.Methods The diagnosis and treatment of a patient with hyperkalemia caused by concomitant use of cyclosporine, voriconazole and sacurbatrovalsartan were analyzed. Based on literature review, the possible mechanism by which concomitant use of these drugs led to hyperkalemia was studied. Results After five days of combined administration of these drugs, the serum level of potassium began to exceed the upper limit. After withdrawal of cyclosporine and sulbactam, the serum level of potassium did not return to normal within five days until voriconazole was discontinued. There was no abnormal level of serum potassium when voriconazole was administered a second time. All this suggested that the combination of cyclosporine, voriconazole and sacurbatrovalsartan increased the risk of cyclosporine induced hyperkalemia.Conclusion When cyclosporine, voriconazole, and drugs acting on the renin-angiotensin-aldosterone system are administered in combination, hyperkalemia is likely to occur even if the blood concentration of cyclosporine is at a relatively low level.

Key words: cyclosporine, voriconazole, systemic lupus erythematosus, hyperkalemia, drug interaction

中图分类号:

R969.2R994.11

杨晓雯, 王晓星. 环孢素联合用药致高钾血症1例及文献分析[J]. 中国药物警戒, 2021, 18(12): 1192-1195.

YANG Xiaowen, WANG Xiaoxing. One Case of Hyperkalemia Induced by Concomitant Use of Cyclosporine and Other Drugs[J]. Chinese Journal of Pharmacovigilance, 2021, 18(12): 1192-1195.

参考文献

[1] Awni WM.Pharmacodynamic monitoring of cyclosporin[J]. Clin Pharmacokinet, 1992, 23(6): 428-448.
[2] Moroni G, Doria A, Mosca M, et al.A randomized pilot trial comparing cyclosporine and azathioprine for maintenance therapy in diffuse lupus nephritis over four years[J]. Clin J Am Soc Nephrol, 2006, 1(5): 925-932.
[3] Pavleska-Kuzmanovska S, Popov Z, Ivanovski O, et al.Cyclosporine nephrotoxicity and early posttransplant hyperkalemia in living-donor renal recipients: report of 4 cases[J]. Exp Clin Transplant, 2014, 12(5): 479-483.
[4] Qiu CY, Sui YY, Yu LX, et al.Clinical analysis on hyperpotassemia induced by pharmacologic interaction between tacrolimus and other drugs in 10 renal transplant recipients[J]. Organ Transplantation(器官移植) , 2017, 8(1): 40-43.
[5] Mcmurray JJ, Packer M, Desai AS, et al.Angiotensin-neprilysin inhibition versus enalapril in heart failure[J]. New Engl J Med, 2014, 371(11): 993-1004.
[6] Xie C, Ye J, Miao LY.Analysis of Clinical application of angiotensin receptor enkephalinase inhibitor sacubitril valsartan in 61 patients with heart failure[J]. China Pharmacy(中国药房) , 2019, 30(8): 1124-1127.
[7] Zou ZL.Literature analysis of 31 adverse drug reaction/event cases induced by voriconazole[J]. Chinese Journal of Pharmacovigilance(中国药物警戒) , 2013, 10(10): 623-626.
[8] Wang XM, Zhang L.Analysis of 84 cases of adverse reactions induced by voriconazole[J]. Herald of Medicine(医药导报), 2017, 36(12): 1432-1436.
[9] Ding XF.Hyperkalemia developed by the use of ciclosporin combination with voriconazole[J]. The Chinese Journal of Clinical Pharmacology(中国临床药理学杂志), 2012, 28(2): 146-147.
[10] Tian M, Liu XM, Liu P, et al.The diagnosis and treatment of hyperkalemia caused by calcineurin inhibitor associated nephrotoxicity after liver transplantation[J]. Chinese Journal of Transplantation(中华移植杂志), 2016, 10(1): 37-40.
[11] Zhou XL, Wei LN, Lyu WW.Hyperkalemia induced by pharmacologic interaction between tacrolimus and other drugs after liver transplantation[J]. Practical Pharmacy and Clinical Remedies(实用药物与临床杂志), 2018, 21(5): 598-600.
[12] Nazmul MN, Miles CD, Westphal SG.Severe hyperkalemia complicating voriconazole treatment in a kidney transplant recipient with histoplasmosis: a case report[J]. Transplant Proc, 2017, 49(10): 2372-2373.
[13] Deng ZT.Analysis of a case of hyperbaitemia associated with voriconazole due to drug interaction[J]. Chinese Journal of Drug Abuse Prevention and Treatment(中国药物滥用防治杂志), 2019, 25(1): 53-55, 59.
[14] Bantle JP, Nath KA, Sutherland DE, et al.Effects of cyclosporine on the renin-angiotensin-aldosterone system and potassium excretion in renal transplant recipients[J].Arch Intern Med, 1985, 145(3): 505-508.
[15] Kamel KS, Ethier JH, Quaggin S, et al.Studies to determine the basis for hyperkalemia in recipients of a renal transplant who are treated with cyclosporine[J]. J Am Soc Nephrol, 1992, 2(8): 1279-1284.
[16] Ghnaimat M, Akash N, El-Lozi M.Cyclosporine a induced hyperkalemia in a renal allograft recipient[J]. Saudi J Kidney Dis Transpl, 1996, 7(3): 315-316.
[17] Pei Y, Richardson R, Greenwood C, et al.Extrarenal effect of cyclosporine A on potassium homeostasis in renal transplant recipients[J]. Am J Kidney Dis, 1993, 22(2): 314-319.
[18] Sonino N.The use of ketoconazole as an inhibitor of steroid production[J]. N Engl J Med, 1987, 317(13): 812-818.
[19] Duman AK, Fulco PP.Adrenal insufficiency with voriconazole and inhaled/intranasal corticosteroids: case report and systematic review[J]. J Pharm Pract, 2017, 30(4): 459-463.

环孢素联合用药致高钾血症1例及文献分析

One Case of Hyperkalemia Induced by Concomitant Use of Cyclosporine and Other Drugs

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

[1]	吕鹏, 张京莉, 王运红, 马芬芬, 张玉, 黄怡菲. 伏立康唑致肺移植受者皮肤鳞状细胞癌危险因素及机制研究进展[J]. 中国药物警戒, 2023, 20(5): 595-600.
[2]	胡碧原, 汪静, 郑微旗, 胡宏平, 陈泳伍. 注射用伏立康唑致自杀倾向与感觉异常1例分析[J]. 中国药物警戒, 2023, 20(4): 469-472.
[3]	张雯雯, 聂西庭, 徐会茹, 冉晔, 田成林, 于生元. 华法林片联合复方氨酚烷胺片致凝血功能极度异常1例分析[J]. 中国药物警戒, 2023, 20(11): 1290-1292.
[4]	谢婧, 关飞. 药物诱发髂腰臀肌自发性出血1例分析[J]. 中国药物警戒, 2023, 20(11): 1299-1302.
[5]	赵瑞, 于晓佳, 安卓玲. 1例大剂量胺碘酮诱发伊伐布雷定闪光现象的药学监护[J]. 中国药物警戒, 2023, 20(10): 1173-1175.
[6]	曹鑫, 崔向丽. 移植患者伏立康唑对免疫抑制剂的浓度及临床结局影响[J]. 中国药物警戒, 2022, 19(2): 193-195.
[7]	张黎, 陈海涛, 陈学梁, 高秀蓉. 1例伏立康唑联合米卡芬净治疗慢性阻塞性肺疾病合并侵袭性肺曲霉菌感染患者的药学监护[J]. 中国药物警戒, 2022, 19(12): 1380-1383.
[8]	汪乐尘, 沈爱宗. 安徽省某三甲医院伏立康唑致低钾血症不良反应分析[J]. 中国药物警戒, 2022, 19(11): 1238-1241.
[9]	张晓娟, 杨宏昕, 郭小彬, 解沛涛. 伏立康唑片引起幻视和幻觉不良反应2例及相关文献回顾[J]. 中国药物警戒, 2021, 18(6): 588-591.
[10]	曹鑫, 孙玉泉, 黄贵民, 冉仲阳, 崔向丽. 他克莫司与伏立康唑联合使用不良反应信号挖掘与分析[J]. 中国药物警戒, 2021, 18(5): 483-488.
[11]	张泰, 王岩艳. 药用辅料影响诊疗安全研究进展[J]. 中国药物警戒, 2021, 18(5): 492-494.
[12]	吕锦涛, 张丹, 张冰, 萨日娜, 林志健, 张晓朦. 柑橘属中药的药物相互作用研究进展[J]. 中国药物警戒, 2021, 18(5): 495-498.
[13]	毛敏, 廖明燕, 毛建. 含聚乙二醇环孢素注射液致过敏性休克1例分析[J]. 中国药物警戒, 2021, 18(3): 274-276.
[14]	程金莲, 欧阳绘天, 靳洪涛, 朱雪琦, 肖爽, 雷翔, 高春升, 刘清泉. 中药临床研究联合用药安全性评价的思考和建议[J]. 中国药物警戒, 2021, 18(1): 4-10.
[15]	袁守军. 几种常用药物联用计算方法的数学瑕疵和一带一线模型法的解决方案[J]. 中国药物警戒, 2021, 18(1): 11-17.