一例服用左氧氟沙星的胰腺癌患者因使用美沙酮而出现 QT 间期延长趋势的病例。

IF 1.2 Q4 PHARMACOLOGY & PHARMACY
Ryusuke Ouchi, Munenori Nagao, Shinju Suzuki, Toshihiro Yamagata, Mie Chiba, Naoko Kurata, Kensuke Usui, Takashi Watanabe, Kaori Koyama, Kouji Okada
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引用次数: 0

摘要

背景:美沙酮可防止阿片类药物耐药性的产生,因此可用于缓解癌症相关疼痛,而其他阿片类药物难以控制癌症相关疼痛。QT 间期延长是美沙酮治疗的一个严重副作用,据报道有一些患者因此死亡。特别是,由于 QT 间期延长的风险增加,在与同样会延长 QT 间期的药物联合使用时应谨慎:本研究介绍了一例美沙酮与左氧氟沙星合用的病例,患者(男性,60 多岁)已经在使用左氧氟沙星,而左氧氟沙星会延长 QT 间期--这是美沙酮治疗的严重副作用--其 QTc 值呈上升趋势。鉴于左氧氟沙星会增加 QT 间期延长的风险,我们考虑在引入美沙酮之前改用其他抗菌药物。然而,由于神经外科医生认为控制脑脓肿是当务之急,因此我们在继续使用左氧氟沙星的同时引入了小剂量美沙酮。由于存在风险,我们频繁进行心电图检查。因此,我们在 QTc 上升到达到 QT 间期延长的诊断标准之前就采取了应对措施。因此,我们避免了药物引起的长 QT 综合征的发生:结论:在考虑使用美沙酮治疗顽固性癌痛时,必须消除可能导致 QT 间期延长的危险因素。然而,由于合并症可能难以停用伴随药物,在某些情况下,即使使用低剂量美沙酮,QT 间期延长的风险也可能增加。在这种情况下,经常进行监测,即使是像本病例中使用的这种简单的测量方法,也有可能防止病情恶化到更严重的程度。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A case with a trend of QT interval prolongation due to the introduction of methadone to a pancreatic cancer patient on levofloxacin.

Background: As methadone can prevent the development of opioid resistance, it has application in alleviating cancer-related pain that proves challenging to manage with other opioids. QT interval prolongation is a serious side effect of methadone treatment, with some reported deaths. In particular, owing to the increased risk of QT interval prolongation, caution should be exercised when using it in combination with drugs that also prolong the QT interval.

Case presentation: This study presents a case in which methadone was introduced to a patient (a man in his 60s) already using levofloxacin, which could prolong the QT interval-a serious side effect of methadone treatment-and whose QTc value tended to increase. Given that levofloxacin can increase the risk of QT interval prolongation, we considered switching to other antibacterial agents before introducing methadone. However, because the neurosurgeon judged that controlling a brain abscess was a priority, low-dose methadone was introduced with continuing levofloxacin. Owing to the risks, we performed frequent electrocardiograms. Consequently, we responded before the QTc increased enough to meet the diagnostic criteria for QT interval prolongation. Consequently, we prevented the occurrence of drug-induced long QT syndrome.

Conclusions: When considering the use of methadone for intractable cancer pain, it is important to eliminate possible risk factors for QT interval prolongation. However, as it may be difficult to discontinue concomitant drugs owing to comorbidities, there could be cases in which the risk of QT interval prolongation could increase, even with the introduction of low-dose methadone. In such cases, frequent monitoring, even with simple measurements such as those used in this case, is likely to prevent progression to more serious conditions.

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来源期刊
CiteScore
1.80
自引率
0.00%
发文量
29
审稿时长
8 weeks
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