Colchicine Drug Interaction Errors and Misunderstandings: Recommendations for Improved Evidence-Based Management.
Colchicine Drug Interaction Errors and Misunderstandings: Recommendations for Improved Evidence-Based Management.
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秋水仙碱药物相互作用错误和误解：改善基于证据的管理的建议。
DOI：
10.1007/s40264-022-01265-1
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发表时间：
2023-03
期刊：
影响因子：
4.2
通讯作者：
Malone, Daniel C.
中科院分区：
文献类型：
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作者：
Hansten, Philip D.;Tan, Malinda S.;Horn, John R.;Gomez-Lumbreras, Ainhoa;Villa-Zapata, Lorenzo;Boyce, Richard D.;Subbian, Vignesh;Romero, Andrew;Gephart, Sheila;Malone, Daniel C.
秋水仙碱可用于预防和治疗痛风和各种其他疾病。它是CYP 3A 4和P-糖蛋白（P-gp）的底物，与CYP 3A 4/P-gp抑制剂合并给药可引起危及生命的药物相互作用（DDI），如全血细胞减少症、多器官衰竭和心律失常。秋水仙碱也可引起肌毒性，与其他肌毒性药物合用可能增加肌病和横纹肌溶解的风险。DDI信息的许多来源，包括期刊出版物、产品标签和在线来源，都有关于哪些药物与秋水仙碱相互作用的错误或误导性陈述，以及管理DDI以最大限度地减少患者伤害的次优建议。此外，对特定秋水仙碱DDI的临床重要性的评估可能因来源不同而差异很大。在本文中，我们提供了一个基于证据的评估，哪些药物可以预期与秋水仙碱相互作用，哪些药物已被声明与秋水仙碱相互作用，但不太可能这样做。基于这些评估，我们建议管理方案，以减少秋水仙碱DDI的潜在严重不良后果的风险。当与CYP 3A 4/P-gp抑制剂一起给药时，减少秋水仙碱剂量的常见建议可能会导致某些患者的秋水仙碱毒性和其他患者的治疗失败。对近100例秋水仙碱DDI报告病例的综合评价以表格形式列入电子补充材料。秋水仙碱是一种有价值的药物，但需要改进有关秋水仙碱DDI的信息，以尽量减少严重不良后果的风险。在线版本包含补充材料，可通过10.1007/s40264-022-01265-1获得。
Colchicine is useful for the prevention and treatment of gout and a variety of other disorders. It is a substrate for CYP3A4 and P-glycoprotein (P-gp), and concomitant administration with CYP3A4/P-gp inhibitors can cause life-threatening drug–drug interactions (DDIs) such as pancytopenia, multiorgan failure, and cardiac arrhythmias. Colchicine can also cause myotoxicity, and coadministration with other myotoxic drugs may increase the risk of myopathy and rhabdomyolysis. Many sources of DDI information including journal publications, product labels, and online sources have errors or misleading statements regarding which drugs interact with colchicine, as well as suboptimal recommendations for managing the DDIs to minimize patient harm. Furthermore, assessment of the clinical importance of specific colchicine DDIs can vary dramatically from one source to another. In this paper we provide an evidence-based evaluation of which drugs can be expected to interact with colchicine, and which drugs have been stated to interact with colchicine but are unlikely to do so. Based on these evaluations we suggest management options for reducing the risk of potentially severe adverse outcomes from colchicine DDIs. The common recommendation to reduce the dose of colchicine when given with CYP3A4/P-gp inhibitors is likely to result in colchicine toxicity in some patients and therapeutic failure in others. A comprehensive evaluation of the almost 100 reported cases of colchicine DDIs is included in table form in the electronic supplementary material. Colchicine is a valuable drug, but improvements in the information about colchicine DDIs are needed in order to minimize the risk of serious adverse outcomes. The online version contains supplementary material available at 10.1007/s40264-022-01265-1.
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