頁籤選單縮合
題名 | Statin類藥物引起肌肉病變之探討=Statin-related Myopathy |
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作者姓名(中文) | 林秀芬; 陳麗芳; | 書刊名 | 藥學雜誌 |
卷期 | 27:2=107 2011.06[民100.06] |
頁次 | 頁116-120 |
分類號 | 418.227 |
關鍵詞 | 降血脂藥物; 肌肉病變; 藥物不良反應; Statin; Myopathy; Myalgia; Myositis; Rhabdomyolysis; Isoprenoid; |
語文 | 中文(Chinese) |
中文摘要 | 肌肉病變是使用 statin類藥物常常被忽略的藥物不良反應,嚴重度從肌痛、肌炎到橫紋肌溶解。 Statin類藥物引起肌肉病變的病理機轉目前尚未十分清楚,目前的研究認為, statin類藥物抑制膽固醇生合成路徑過程中,造成「 isoprenoid depletion」是主要的關鍵因素。同時具有高脂溶性與高 HMG-CoA reductase抑制效力特性的 statin比較容易誘發肌肉病變的發生;另一方面, statin血中濃度越高,引起肌肉病變的危險性也相對的增加。肌肉病變發生時,停止可疑 statin的使用是最安全的處置;若臨床上碰到無法避免使用的情形,基於用藥安全的考量,可以參考 2006年N LA對 statin類藥物引起肌肉病變的處置建議。為了預防肌肉病變的發生,使用時應從最低有效劑量開始使用,並避免併用會增加 statin血中濃度的藥物;醫師與藥師應告知使用者有關 statin引起肌肉病變的相關訊息,以提升用藥安全性。 |
英文摘要 | Myopathy is an easily overlooked adverse drug reacton on statin therapy. The spectrum of statin-related myopathy includes myalgia, myositis and rhabdomyolysis according to the severity classification. The precise mechanisms underlying statin myopathy are incompletely understood, but statin-induced isoprenoid depletion in the cholesterol biosynthesis pathway may be a key factor. Statins associated with higher risk for myopathy are those that have both a higer potency on HMG-CoA reductase inhibition and are relatively lipophilic; in addition, the higher the statin blood concentration, the higher the risk for myopathy. If myopathy develops, discontinue the offending statin is the safest management; the 2006 NLA recommendations for managing statin myopathy may be considered when statin use is unavoidable. For myopathy prevention, the clinician should prescribe the lowest effective statin dose and avoid combination with drugs which may result in statin concentration elevation; in addition, the clinician and pharmacist must advise patients of informations about statinrelated myopathy to enhance drug safety. |
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