一种罕见的冠状动脉血管痉挛并发症,与同时使用麦角胺、钴司他和达芦那韦相关

IF 1.3 4区 医学 Q4 INFECTIOUS DISEASES
Cheng-En Wu, Chun-Hsien Wu, S. Tsai, Wen-I Liao
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引用次数: 1

摘要

Ergotism是一种罕见的外周血管收缩原因,其表现因受影响的血管而异。冠状动脉血管痉挛是一种罕见的、可能致命的麦角主义表现。细胞色素P-450同工酶CYP3A代谢麦角生物碱及其衍生物;因此,同时使用麦角胺和CYP3A抑制剂会显著增加麦角病的风险。抗逆转录病毒药物达芦那韦与钴司他加强有效地抑制CYP3A。文献中描述了麦角胺与增强型人类免疫缺陷病毒蛋白酶抑制剂联合使用时的一些有害相互作用。在此,我们描述了一名因麦角胺与达芦那韦和科比司他相互作用而导致严重冠状动脉血管痉挛而急诊科就诊的患者。急诊冠状动脉造影显示没有严重的动脉粥样硬化狭窄,但冠状动脉痉挛时间延长。经过及时心肺复苏、静脉扩张治疗和14天体外膜肺氧合应用,患者完全康复出院。同时使用麦角生物碱及其衍生物可能对使用钴甾体达芦那韦治疗的患者造成灾难性后果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A rare complication of coronary vasospasm associated with concomitant use of ergotamine, cobicistat, and darunavir
Ergotism is a rare cause of peripheral vasoconstriction with varying presentation depending on the affected vessels. Coronary vasospasm is a rare, potentially fatal manifestation of ergotism. Cytochrome P-450 isoenzyme CYP3A metabolizes ergot alkaloids and their derivatives; thus, concomitant use of ergotamine and CYP3A inhibitors significantly increases ergotism risk. The antiretroviral drug darunavir boosted with cobicistat potently inhibits CYP3A. A few deleterious interactions are described in the literature when combining ergotamine with boosted human immunodeficiency virus protease inhibitors. Herein, we describe a patient who presented to the emergency department with profound coronary vasospasm arising from ergotamine’s interaction with darunavir and cobicistat. Emergency coronary angiography revealed no critical atherosclerotic stenosis, but prolonged coronary artery spasm. After prompt cardiopulmonary resuscitation, intravenous vasodilator treatment, and 14-day extracorporeal membrane oxygenation application, the patient fully recovered and was discharged. Concomitant use of ergot alkaloids and their derivatives could be disastrous for patients treated with cobicistat-boosted darunavir.
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来源期刊
Antiviral Therapy
Antiviral Therapy 医学-病毒学
CiteScore
2.60
自引率
8.30%
发文量
35
审稿时长
4-8 weeks
期刊介绍: Antiviral Therapy (an official publication of the International Society of Antiviral Research) is an international, peer-reviewed journal devoted to publishing articles on the clinical development and use of antiviral agents and vaccines, and the treatment of all viral diseases. Antiviral Therapy is one of the leading journals in virology and infectious diseases. The journal is comprehensive, and publishes articles concerning all clinical aspects of antiviral therapy. It features editorials, original research papers, specially commissioned review articles, letters and book reviews. The journal is aimed at physicians and specialists interested in clinical and basic research.
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