从1例反复支架内血栓伴抑郁患者探讨舍曲林与抗血小板药物的相互作用.pdfVIP

中国药物应用与监测 2015 年4 月第12卷第2 期 Chinese Journal of Drug Application and Monitoring, Vol.12, No.2, April 2015 ·临床药师园地 · 从1 例反复支架内血栓伴抑郁患者探讨舍曲林与抗血小板药物的相互作用 1,2 1 2 3 （1.首都医科大学宣武医院药剂科，北京 100053 ；2. 解放军总医院药品保障中心，北京 张青霞 ，闫素英 ，裴 斐 ，李丹丹 100853；3. 解放军总医院心血管内科，北京 100853 ） [摘要]　1例反复支架内血栓的老年男性患者，因确诊“冠状动脉粥样硬化性心脏病，不稳定型心绞痛，陈旧性下壁、前壁心 肌梗死”入院，入院后给予阿司匹林肠溶片（75 mg ，qd ）+ 替格瑞洛片（90 mg ，bid ）+ 西洛他唑片（50 mg ，qd ）强化抗栓治疗 和其它常规治疗后患者仍然反复发作心绞痛症状。神内科医生会诊后诊断为抑郁症而加用盐酸舍曲林（25 mg ，qd ）。临床药 师重点关注舍曲林与抗血小板药物间的相互作用，密切关注患者皮肤、黏膜等出血情况，发现在合并使用舍曲林10 d后患者 牙龈出血，考虑为舍曲林与替格瑞洛、西洛他唑的相互作用所致，立即停用舍曲林并经凝血酶冻干粉漱口、云南白药胶囊口 含后出血停止。鉴于舍曲林与某些抗血小板药物（替格瑞洛、西洛他唑）有显著的药物相互作用，建议根据病情谨慎选择药 物的品种，如需联用应密切监测。 [关键词]　舍曲林；抗血小板药物；替格瑞洛；西洛他唑；相互作用 [ 中图分类号]　R969.2　　 [ 文献标识码]　A　 [ 文章编号]　1672 – 8157(2015)02 – 0085 – 03 Investigation of the interaction between sertraline and antiplatelet drugs through a patient of repeated in-stent thrombus with depression 1,2 1 2 3(1. Department of Pharmacy, Xuanwu Hospital of Capital Medical ZHANG Qing-xia , YAN Su-ying , PEI Fei , LI Dan-dan University, Beijing 100053, China; 2. Department of Pharmaceutical Care, PLA General Hospital, Beijing 100853, China; 3. Department of Cardiology, PLA General Hospital, Beijing 100853, China) [ABSTRACT]　One elderly male patient with repeated in-stent thrombus was hospitalized for unstable angina pectoris, inferior and anterior old myocardial infarction. Triple intensive antiplatelet therapy (aspirin 75 mg, qd + ticagrelor 90 mg, bid + cilostazol 50 mg, qd) and other routine treatment were performed simultaneously after admission, but the patient still felt attacks of reoccurrent angina. The patient was diagnosed as depression by the neurologist and was given sertraline hydrochloride (25 mg, qd). Clinical pharmacists paid more attention to the drug interaction between sertraline and antiplatelet drugs. Gingival bleeding happened 1