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 Printable version |
Analysis of an adverse event on a pharmacodependant to drugs patient: focus on risks of drugs interactions related to cytochromes |
Journal de Pharmacie Clinique. Volume 24, Number 3, 186-91, juillet-août-septembre 2005, Article original
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 Résumé
Article gratuit
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Author(s) : A Maslin, D Cabelguenne, F Meunier, A Sourty, J Doucet |
Summary : We report the case of a prisoner complaining about ebrious feelings, dizziness and a loss of vigilance following the daily concomitant administration of 20 mg of esomeprazole (Inexium
®), 100 mg of diclofenac (Voltarene
®), 50 mg of clorazepate (Tranxene
®) and 60 mg of methadone. In order to establish the origin of this adverse event, a review of the administred drugs pharmacological, pharmacokinetic and pharmacogenetic characteristics was carried out. After comparing with the drug’s history, described clinical signs and analysis of the relevant literature, the medical and pharmaceutical staffs considered five hypothesis at the origin of this adverse effect: 1) the patient is “a poor metabolizer” whose lack of cytochromes P450 (CYP) 2C19 led to a clorazepate overdose\; 2) the patient is “a poor metabolizer” for the CYP2D6, at the origin of a methadone overdose\; 3) drug interaction related to the gastric pH variation induced by the esomeprazole with modification of the methadone’s absorption\; 4) drug interaction with implication of the diclofenac metabolized by CYP2C9\; 5) drug interaction with clorazepate overdose: interaction methadone-clorazepate, methadone is metabolized by CYP3A4 and 2D6 or esomeprazole-clorazepate, drugs metabolized via the CYP2C19 which is inhibited by the esomeprazole. In conclusion, the fifth hypothesis seemed to be the most probable. It was discussed during the medical and pharmaceutical meeting for an adapted treatment of pharmacodependant patients regarding their drug profile. |
Keywords : esomeprazole, clorazepate, methadone, diclofenac, drug interactions, adverse event, cytochrome |
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