تداخلات دوائية مهمة .. **************** من الوصفات المتكررة للاسف استخدام علاج gemfibrozil الاسم التجاري له lopid متزامنا مع اي علاج ينتمي الى مجموعة statins طبعا ايه خطورته ؟ بيزيد من الاثر السمي بدرجة سريرية عالية على الكبد بالاضافة الى وهن والام وتكسر في العضلات وتبعات ذلك على الكلى . اقل ما يمكن الحديث عنه في شان هذا التداخل انه relative contraindication وبيحتاج الى فحوصات ومراقبة مستمرة من قبل الطبيب اللي صرفه بالاضافة انه الحد الاعلى المسموح من جرعة statins مختلف . طبعا بالنسبة لعلاج simvastain مع gemfibrozil فهو contraindication مش relative !! لمزيد من التفاصيل عن الموضوع : Severe myopathy and rhabdomyolysis have been reported during concomitant use of HMG-CoA reductase inhibitors and fibric acid derivatives, especially gemfibrozil. Myopathy manifested as muscle pain and/or weakness associated with grossly elevated creatine kinase exceeding ten times the upper limit of normal has been reported occasionally. Rhabdomyolysis has also occurred rarely, which may be accompanied by acute renal failure secondary to myoglobinuria and may result in death. MANAGEMENT: Concurrent use of fibric acid derivatives and HMG-CoA reductase inhibitors should generally be avoided unless the benefit of further alterations in lipid levels is anticipated to outweigh the potential risks. Addition of fibrates to HMG-CoA reductase inhibitor therapy typically provides little additional reduction in LDL cholesterol, but further reductions of triglycerides and increases in HDL cholesterol may be attained. If the combination is prescribed, a fibrate other than gemfibrozil may be preferable, along with lower initial dosages of the HMG-CoA reductase inhibitor. If gemfibrozil is used, rosuvastatin daily dosage should not exceed 10 mg. Lovastatin labeling recommends that the dosage not exceed 20 mg daily when prescribed with gemfibrozil or other fibrates . All patients treated with HMG-CoA reductase inhibitors and/or fibrates should be advised to promptly report any unexplained muscle pain, tenderness or weakness, particularly if accompanied by fever, malaise and/or dark colored urine. Therapy should be discontinued if creatine kinase is markedly elevated in the absence of strenuous exercise or if myopathy is otherwise suspected or diagnosed. In addition, patients should be closely monitored for hepatotoxicity
Posted on: Sun, 17 Aug 2014 21:33:54 +0000
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