カルシウムチャネルブロッカー-クラリトロミシン 薬物相互作用と急性腎臓損傷
Sonja Gandhi1, Jamie L Fleet2, David G Bailey3
1Division of Nephrology, Department of Medicine, Western University, London, Canada2Department of Epidemiology and Biostatistics, Western University, London, Canada.
JAMA
|December 19, 2013
まとめ
カルシウムチャネルブロッカーを服用している高齢者は,クラリトロマイシンとアジトロマイシンが処方されたときに,急性腎臓損傷と低血圧のリスクが高かった. この研究は,CYP3A4阻害剤とカルシウムチャネルブロッカーの間の潜在的な薬物相互作用を強調しています.
科学分野:
- 薬理学 薬理学とは
- 薬物相互作用 薬物相互作用
- ゲリアトリック・メディシン (老年医学)
背景:
- カルシウムチャネルブロッカー (CCB) は,サイトクロームP450 3A4 (CYP3A4) によって代謝されます.
- CYP3A4の抑制は,CCBの血中濃度の上昇と潜在的な毒性につながる可能性があります.
- クラリトロミシンはCYP3A4阻害剤であり,アジトロミシンはそうではないため,比較薬物相互作用研究に適しています.
研究 の 目的:
- 高齢者における急性有害事象のリスクを評価するために,CCBを服用中にクラリトロマイシンとアジトロマイシンを併用して処方した.
- CCBの使用の文脈でクラリトロマイシンとアジトロマイシンの安全性プロフィールを比較する.
主な方法:
- カナダのオンタリオ州 (2003年−2012年) で実施された人口をベースにした遡及的なコホート研究.
- 新しく共同処方されたクラリトロマイシン (n=96,226) またはアジトロマイシン (n=94,083) をCCBと併用した高齢者 (平均年齢76歳) を含む.
- プライマリアウトカム:急性腎臓損傷による入院;二次アウトカム:低血圧による入院および30日以内に評価されたあらゆる原因による死亡率.
主要な成果:
- クラリトロマイシンとCCBの併用は,アジトロマイシンと比較して,急性腎臓損傷のために入院するリスクが高い (OR,1.98) と関連していました.
- 特に,ニフェディピンなどのディヒドロピリジンのCCBでリスクの増加が認められた.
- また,クラリトロマイシンの使用は,低血圧 (OR,1.60) と全原因死亡率 (OR,1.74) のリスクの増加と関連していました.
結論:
- 高齢者におけるクラリトロマイシンとCCBの同時使用は,急性腎臓損傷の30日間のリスクのわずかなが有意な増加と関連しています.
- この発見は,CYP3A4阻害剤とCCBを併用することに対する既存の警告を裏付けている.
- この研究は,マクロリド抗生物質をCCBの患者に処方する際に薬物代謝経路を考慮することの重要性を強調しています.
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