背景:他汀类药物广泛用于心血管疾病(CVD)作为一种常见的降脂药物,而喹诺酮类药物广泛用于治疗传染病。通常会看到CVD与传染病相结合,因此,他汀类药物和喹诺酮类药物经常联合使用。数据表明,他汀类药物和喹诺酮类药物的组合可能与潜在的危及生命的肌病有关。横纹肌溶解症和急性肝炎。本系统综述旨在描述受他汀类药物-喹诺酮类药物相互作用影响的患者的相关数据。
方法:本系统综述的目的是收集和评估他汀类药物-喹诺酮类药物相互作用的证据,并讨论相关的风险缓解策略。搜索了以下数据库:PubMed(Medline),Embase,Scopus,科克伦图书馆使用以下搜索词进行了系统的电子文献检索。在这项研究中,使用了三种类型的搜索术语:他汀类药物相关术语,喹诺酮类相关术语,和药物相互作用相关术语。
结果:有16例病例报告符合定性分析标准。患者发生以下不良反应:横纹肌溶解症(n=12),急性肝炎(n=1),肌肉无力(n=1),髋关节肌腱病(n=1),或肌病(n=1)。在包含的文献中,患者服用他汀类药物的剂量和类型各不相同,包括20-80mg/d剂量范围的辛伐他汀(n=10)和80mg/d剂量的阿托伐他汀(n=4)。有2例患者使用未指定剂量的他汀类药物,分别使用辛伐他汀和阿托伐他汀。喹诺酮类药物的组合为环丙沙星(n=9),剂量范围为800-1500mg/d,左氧氟沙星(n=6),剂量范围为250-1000mg/d,和诺氟沙星(n=1)在未指定的剂量范围。81%的病例患者年龄在60岁以上,约1/3患有肾脏相关疾病,如糖尿病肾病,移植后,和严重的肾小球肾炎.近三分之二的患者同时服用细胞色素P4503A4(CYP3A4)抑制剂,P-糖蛋白(P-gp)抑制剂,或有机阴离子转运多肽1B1(OATP1B1)抑制剂。
结论:他汀类药物-喹诺酮类药物联合治疗的患者应更密切地监测天冬氨酸氨基转移酶或肌酸激酶(CK)水平的变化,和肌肉症状,尤其是环丙沙星或左氧氟沙星患者,辛伐他汀和大剂量阿托伐他汀,60岁以上,与肾脏相关的疾病,以及伴随的CYP3A4抑制剂。
BACKGROUND: Statins are widely used in cardiovascular disease (CVD) as a common lipid-lowering drug, while quinolones are widely used for the treatment of infectious diseases. It is common to see CVD in combination with infectious diseases, therefore it is often the case that statins and quinolones are used in combination. Data suggest combinations of statin and quinolone may be associated with potentially life-threatening myopathy, rhabdomyolysis and acute hepatitis. This systematic review aims to characterize data regarding patients affected by the statin-quinolone interaction.
METHODS: The purpose of this systematic review was to collect and evaluate the evidence surrounding statin-quinolone drug interactions and to discuss related risk mitigation strategies. The following databases were searched: PubMed (Medline), Embase, Scopus, and Cochrane Library. The systematic electronic literature search was conducted with the following search terms. In this study, three types of search terms were used: statins-related terms, quinolones-related terms, and drug interactions-related terms.
RESULTS: There were 16 case reports that met the criteria for qualitative analysis. Patients were involved in the following adverse reactions: rhabdomyolysis (n = 12), acute hepatitis (n = 1), muscle weakness (n = 1), hip tendinopathy (n = 1), or myopathy (n = 1). In the included literature, patients vary in the dose and type of statins they take, including simvastatin (n = 10) at a dose range of 20-80 mg/d and atorvastatin (n = 4) at a dose of 80 mg/d. There were 2 patients with unspecified statin doses, separately using simvastatin and atorvastatin. The quinolones in combination were ciprofloxacin (n = 9) at a dose range of 800-1500 mg/d, levofloxacin (n = 6) at a dose range of 250-1000 mg/d, and norfloxacin (n = 1) in an unspecified dose range. 81% of the case patients were over 60 years of age, and about 1/3 had kidney-related diseases such as diabetic nephropathy, post-transplantation, and severe glomerulonephritis. Nearly two-third of the patients were on concomitant cytochrome P450 3A4 (CYP3A4) inhibitors, P-glycoprotein (P-gp) inhibitors, or organic anion transporting polypeptide 1B1 (OATP1B1) inhibitors.
CONCLUSIONS: Patients treated with statin-quinolone combination should be monitored more closely for changes in aspartate aminotransferase or creatine kinase (CK) levels, and muscle symptoms, especially in patients with ciprofloxacin or levofloxacin, with simvastatin and high-dose atorvastatin, over 60 years of age, with kidney-related diseases, and on concomitant CYP3A4 inhibitors.