尼美舒利肝不良反应再评价

尼美舒利（nimesulide）系磺酰苯胺类非甾体抗炎药（NSAIDs），具有良好的抗炎、镇痛和解热作用，适用于骨关节炎、类风湿关节炎等慢性关节炎症、上呼吸道感染引起的发热等多种疾病和症状的治疗。     

尼美舒利的不良反应

目的介绍尼美舒利的不良反应,为临床安全、有效、合理用药提供参考。方法回顾近几年国内公开发行的医药刊物报道的有关尼美舒利所致的不良反应病例。结果尼美舒利可致肝损害、药疹、全身水肿、血尿等不良反应。结论临床医师、药师应关注尼美舒利的不良反应。     

尼美舒利致肝损害合并腹水

1例55岁女性因腰椎间盘突出症口服尼美舒利0.1 g,2次/d治疗.患者既往无肝病史.连续服药20 d后出现上腹部胀痛、恶心、纳差.肝功能检测:ALT 377 U/L,AST 105 U/L,TBil 13.72 μmol/L.乙肝表面抗原、甲肝抗体、丙肝抗体和戊肝抗体检测均为阴性.B超发现腹水,行腹腔穿刺抽出黄色浑浊液体180 ml,常规检查示:白细胞数1 720×106/L,李凡他试验(+).停用尼美舒利,给予多烯磷脂酰胆碱、复方甘草酸苷、葡醛内酯及左氧氟沙星治疗.入院第10天患者腹水消失,之后肝功能逐渐好转出院;出院2个月后肝功能恢复正常.     

尼美舒利肝脏损害不良反应探究

尼美舒利是非甾体类抗炎药,为选择性环氧化酶-2（COX-2）抑制剂,其耐受性好。近年来,尼美舒利因发生多起导致肝脏损害甚至死亡的严重药品不良反应病例,在一些国家已被停止销售。本文通过对国家药品不良反应监测系统相关数据的检索和分析及典型案例的评价,探讨尼美舒利肝脏损害不良反应,为临床安全、有效、合理用药提供参考。     

尼美舒利致儿童不良反应文献分析

目的:了解尼美舒利致儿童不良反应(ADR)的特征和规律.方法:检索中国期刊全文数据库、万方数字化期刊和维普中文科技期刊数据库,收集2007 ～2010年有关尼美舒利致儿童ADR的文献报道,统计各ADR的性别、年龄、病因、给药情况、ADR出现时间、ADR累及的器官系统与临床表现、转归情况等,并进行总结分析.结果:不良反应...     

尼美舒利致成人斯蒂尔病患者肝肾功能损害

1例22岁初诊成人斯蒂尔病女性患者经甲泼尼龙抗炎以及护肝、护胃等治疗1周,关节痛及体温控制不理想,遂加用尼美舒利100 mg口服,2次/d。用该药前天冬氨酸转氨酶（AST）60 U/L,丙氨酸转氨酶（ALT）50 U/L,肾功能正常。9 d后复查,AST 458 U/L,ALT 450 U/L,怀疑为尼美舒利引起的药物性肝损害,故停用该药并加强护肝治疗。11 d后复查,AST 221 U/L,ALT 97 U/L。因病情需要,再次给予尼美舒利100 mg口服,2次/d。再次用药的第4天晨患者出现排尿困难,血清尿素11.2 mmol/L,肌酐109μmol/L,尿酸435μmol/L;第5天AST 542 U/L,ALT 104 U/L。考虑为尼美舒利引起的肝肾功能损害,停用该药。4 d后患者肾功能指标恢复正常;2周后AST 47 U/L,ALT32 U/L。     

尼美舒利致呃逆1例

患者男，43岁。因慢性腰痛1年行小针刀治疗。术后给予裸花紫珠片2片，po tid；尼美舒利分散片0．1g，po bid。翌日出现呃逆，自行停药后呃逆停止。次日复诊时告知该情况，因从未报道过尼美舒利有此作用，所以告知病人继续服用尼美舒利，停用裸花紫珠片。当晚，病人电话告知，服药后不久又出现呃逆。因此，考虑为尼美舒利所致，嘱病人立即停药。次日复诊时呃逆已自行停止。     

尼美舒利致药物性肝损害1例

患者 ,女 ,4 0岁。因全身肌肉酸痛 ,四肢多关节疼痛 2月 ,查骶髂头节CT示双骶髂关节面密度增高 ,PDD C试验结果 ;红肿 15× 2 0mm2 ,硬结 15× 15mm2 ,门诊诊断为结核变态反应性关节炎 ,致密性骨炎。遵医嘱给予尼美舒利0 .1bidpo ,该患者服用至 1个月时 ,出现恶心、不适 ,当日停服此药 ,发现AST 188U/L ,LDH 2 5 5U/L ,ALT 386U/L ,GLB 4 4G/L ,予以甘草酸二铵 (肝利欣 ) 15 0mg ,维生素C 0 .2加入 10 %葡萄糖注射液 2 5 0mL中静滴 ,qd ,输液致第 10天时 ,复查肝功能正常。尼美舒利是选择性抑制环氧合酶 2 (COX - 2 )的非甾体…     

尼美舒利致不良反应中文文献分析

目的：探讨尼美舒利致不良反应的特点。方法：检索中国期刊全文数据库、维普中文期刊全文数据库、万方科技期刊全文数据库1998～2011年中尼美舒利所致的不良反应文献,对其进行统计分析。结果：尼美舒利所引起的不良反应共计60例,ADR与年龄、性别有关,在妇女、儿童、中老年人中易于发生,临床表现主要为肝胆系统、泌尿系统、皮肤及附件的损害,有3例死亡。结论：临床应重视尼美舒利的不良反应,规范合理用药,保证患者用药安全。     

尼美舒利分散片

通用名:尼美舒利分散片。英文名:Nimesulide Dispersible Tablets。化学名:4-硝基-2-苯氧甲磺酰苯胺。结构式:C13H12N2O5S308.31成分:本品主要成分为尼美舒利。性状:本品为类白色或淡黄色片。剂型特点:本片为分散片,具有服用方便、吸收快、生物利用度高和不良反应小等特点。分散片在20℃水中崩解时限仅为3分钟(普通片剂为15分钟),药物崩解为可通过710μm孔径筛网的混悬液。分散片的这一性质,克服了普通片剂服用时的不便。本品可在温水、牛奶或果汁中,搅拌成混悬状态后服用。药理作用:本品是一种新型非甾体抗炎药,其抗炎作用主要是抑制炎…     

氧氟沙星的不良反应

氧氟沙星为第三代喹诺酮类抗菌素，临床上主要用于革兰阴性菌所致的急、慢性感染，现将氧氟沙星近几年的不良反应报道综述如下：     

Side effects of clozapine

In addition to the low risk of agranulocytosis, several more frequent side effects are associated with clozapine therapy. We tried to estimate the incidence of these side effects. We analysed 391 treatments in 315 inptients, who received clozapine alone or combined with other neuroleptic and antidepressant drugs. Two thirds were combined treatments, one third were treatments with clozapine alone (i.e., no other neuroleptic, antidepressant or anticonvulsive drugs were allowed). The numbers in brackets show the incidence based on the analysis of the treatments with clozapine alone. In 49% (61%) of the treatments a rise in the liver enzyme values was observed. However, counting only the cases in which a two-fold increase over the normal values was observed, the incidence was reduced to 20% (31%). Increase in temperature was observed in 4% (6%) and leukopenia (leukocyte count under 3500/l) was recorded in 2% (2%). Hypotensive dysregulation (systolic blood pressure under 90 mm Hg) was observed in 25% of all treatments and pharmacogenic delirium in 8%. No cases of agranulocytosis were observed. Mean treatment duration was 56 days, mean daily dosage 257 mg. The mean age of the patients was 34 years. In the overall evaluation 71% of the treatments were classified as successful; clozapine therapy was continued after discharge in 68% of the treatments. Adverse reactions (delirium, rise in temperature, hypotension, fatigue, rise in liver enzymes) necessitated a change of medication in 17% of the treatments. Change-over to another neuroleptic drug due to ineffectiveness of clozapine was necessary in 7% of the treatments. The quality of the data is somewhat adversely influenced by the fact that the study was conducted retrospectively on the basis of medical records.     

青霉素的不良反应

青霉素(Pennicillinm，PNC)是B一内酰胺类抗生素．通过抑制菌体细胞壁的合成而发挥杀菌作用．因人体细胞无细胞壁，PNC对其几乎无影响。又因PNC抗菌谱很广．所以深受患者欢迎．成为临床最常用的抗生素之一。但由于近年来大剂量、高浓度使用PNC现象增多，其不良反应屡见发生．现综述如下。     

Side effects of ranitidine

Ranitidine was first marketed in 1981; since then many patients have been treated such that much experience has been accumulated on the safety of this histamine H2-receptor antagonist in the treatment of gastroduodenal disease. A wide array of ranitidine-associated side effects has been described, but infrequently. As so much information is now available, the aim of this review is to assess the weight of evidence for a causal link between ranitidine and the reported side effects. Overall, ranitidine is well tolerated. The incidence of general side effects at less than 2% is very similar to placebo. Headaches, tiredness, dizziness and mild gastrointestinal disturbance (e.g. diarrhoea, constipation and nausea) are among the most frequent complaints, but have very seldom resulted in stopping treatment. Cardiovascular side effects are extremely rare and unpredictable with the usual doses of oral ranitidine (at most 1 in 1 million patients). They mostly comprise sinusal bradycardia and atrioventricular blockade, especially after rapid intravenous administration, receding after cessation of the drug. Clinical studies, however, have not shown a significant pharmacological effect of ranitidine on the cardiovascular system via H2-receptors, even though individual sensitivities cannot be ruled out in a few isolated reports. Ranitidine is unlikely to be directly hepatotoxic: a transient change in liver function tests has been noted in only 1 in 100 to 1 in 1000 patients. Several cases of mixed hepatitis have been reported, but very few were fully documented. The incidence of ranitidine-associated acute hepatitis has been estimated to be less than 1 in 100,000 patients. Neuropsychiatric complications may be less common and clinically quite similar to those reported with cimetidine, i.e. confusion, disorientation, hallucinations, delirium. These side effects have occurred especially in critically ill and multiple-therapy patients, or patients with chronic renal or hepatic failure, so that the direct causal link with ranitidine treatment was often difficult to ascertain. Even though an H2-receptor-mediated effect is an attractive hypothesis (since similar complications were noted with other H2-receptor antagonists), other mechanisms have been suggested to play a role, e.g. cholinergic or histaminic effects. The overall incidence of neuropsychiatric complications is probably markedly less than 1%. White cell injury (i.e. agranulocytosis) appears to be the most frequent haematological complication, even though case reports are very few and poorly documented.(ABSTRACT TRUNCATED AT 400 WORDS)