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From Pharmacy Times(www.pharmacytimes.com)
Thanks to the author Craig I. Coleman, PharmD(Dr. Coleman is an assistant professor of pharmacy practice and director of the pharmacoeconomics and outcomes studies group at the University of Connecticut School of Pharmacy.)
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Fluoxetine Interactions
BD, a 65-year-old man with heart failure, comes to the pharmacy with a prescription for fluoxetine HCl (Prozac) 20 mg a day and tells you that he has been very depressed lately because of his worsening heart failure symptoms. The fourth-year pharmacy intern is working that day and asks if she can enter the prescription and review the patient's medication profile, because she just completed a school examination on heart failure. Under the watchful eye of the precepting pharmacist, the intern reviews the patient's profile and finds that he is currently taking carvedilol (Coreg) 25 mg twice a day. The student is concerned because she recognizes an interaction between BD's current medications and his new prescription.
What is the mechanism behind the interaction, and what is the significance of it? What should the intern/pharmacist do?
ANSWER
Prozac is an inhibitor of the cytochrome P450 (CYP450), isoenzyme CYP2D6, whereas Coreg is a substrate for this isoenzyme. Consequently, the initiation of Prozac in BD could result in increased blood levels of Coreg, placing BD at a higher risk for hypotension, bradycardia, and heart block. The intern and pharmacist should contact the prescribing physician and advise him or her about the potential drug interaction and to recommend a different antidepressant other than Prozac or Paxil (which are both potent CYP2D6 inhibitors).
BD,男,65岁,心衰。他来到药房,带来一张处方:盐酸氟西汀(百忧解)20mg/d,他称最近由于心衰加重,非常郁闷。实习生正好那天在班,她问能不能将处方输入,调阅病人的用药史。巧的是她在学校考试刚好是心衰方面的。在带教药师的监督下,实习生查阅了病人的用药史,发现他正在服用卡维地洛(Coreg)25mg,一天2次。实习生意识到BD现在用的药物与处方上的药物有相互作用。相互作用的机制是什么?这种相互作用有何意义?实习生/药师应该如何做?
答案:百忧解是P450同工酶CYP2D6的抑制剂,Coreg恰好也是这种酶的底物。因此,BD体内的百忧解使卡维地洛的血药浓度上升,这会使他发生低血压、心动过缓、心脏传导阻滞的风险增加。实习生/药师应该与处方医师联系,提示潜在的药物相互作用,建议换用其他抗抑郁药,百忧解和帕罗西汀(二者均为CYP2D6抑制剂)除外。 |
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