1例多潘立酮合用伏立康唑引起心律失常的病例报道

1例75岁男性患者既往没有使用过多潘立酮,既往无心律不齐病史,患者于2015年9月17开始使用多潘立酮片10 mg tid以促进胃肠动力,避免反流。9月21日,尿培养结果提示克柔念珠菌,考虑不除外真菌感染,加用伏立康唑,当日患者出现心律加快,律不齐,25日停用伏立康唑,未停用多潘立酮。直至患者出院(9月30日),患者心律不齐未缓解。判断该患者出现心律不齐是多潘立酮导致的不良反应的关联性评价为可能。多潘立酮主要通过CYP3A4酶代谢,而伏立康唑为CYP3A4酶的强抑制剂,两者合用会降低多潘立酮的代谢,从而增加多潘立酮的浓度。该例患者合用伏立康唑以后,出现心律失常,考虑为伏立康唑导致多潘立酮血药浓度增高或两种药物的心脏不良反应叠加所致。

A case of arrhythmia induced by combined use of domperidone and voriconazole

A 75-year-old male patient without history of arrhythmia took domperidone (Janssen Lot, Batch No:150316766) 10mg tid to promote gastrointestinal motility and avoid regurgitation and aspiration on Sept 17th. And then he was prescribed voriconazole on Sept 21st on which day his heart rate increased with arrhythmias. He stopped taking voriconazole on Sept 25th, while continued using domperidone. Until the patient was discharged (on September 30), his arrhythmias got no remission. It’s possible that domperidone caused the arrhythmias. Domperidone is metabolized primarily by CYP3A4 enzyme, and voriconazole is a strong inhibitor of CYP3A4, therefore the combined use of these two drugs will reduce the metabolism of domperidone, thereby increasing the plasma concentration of domperidone. Arrhythmia appeared after voriconazole were prescribed, so we believe that it was due to the increased plasma concentration of domperidone caused by voriconazole or of the superposition of adverse reactions of these two drugs.