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美国食品和药物管理局警告,称克拉霉素(clarithromycin)与细胞色素P4503A4(CYP3A4)酶底物类药物联合使用会引起严重的不良事件,与钙拮抗剂联合使用会引起低血压,但目前临床上仍有联合使用这两类药物。研究为回顾性队列研究,入选2003-2012年加拿大安大略省在服用钙拮抗剂的基础上联合使用克拉霉素(克拉霉素组,n=96 226)或阿奇霉素(阿奇霉素组,n=94 083)的老年人群共190 309例,平均年龄76岁。观察两组联合服药后30d内急性肾损伤住院(主要观察指标),低血压住院和全因死亡风险(次要观察指标)。结果发现,克拉霉素组的这3项风险均较高。亚组分析结果显示,不同钙拮抗剂类型中,风险最高的是硝苯地平。总之,老年患者中,与钙拮抗剂联合阿奇霉素比较,联合克拉霉素者30d急性肾损伤住院风险较高。
The U.S. Food and Drug Administration warned that the combination of clarithromycin with cytochrome P4503A4 (CYP3A4) enzyme substrate drugs causes serious adverse events that can cause hypotension when used in combination with calcium antagonists, but is currently clinically There is still a combination of these two types of drugs. The study was a retrospective cohort study enrolled in Ontario Ontario, Canada between 2003-2012 using either clarithromycin (clarithromycin, n = 96 226) or azithromycin (azithromycin, n = 94 083) Of 190,309 elderly people with a mean age of 76 years. Inpatients with acute kidney injury (primary outcome measures), hospitalizations for hypotension and risk of all-cause mortality (secondary outcome) were observed within 30 days of the combination therapy. The results showed that the clarithromycin group of three high risk. Subgroup analysis showed that among the different types of calcium antagonists, the highest risk was nifedipine. In short, elderly patients, combined with calcium antagonist azithromycin, combined with clarithromycin 30d acute renal injury higher hospitalization risk.