社團法人臺灣臨床藥學會

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【案例報告】疑似Ticlopidine 引起膽汁鬱積型肝炎之案例報告
Suspected Ticlopidine-Induced Cholestatic Hepatitis
ticlopidine、副作用、膽汁鬱積型肝炎、Ticlopidine, Side Effects, Cholestatic Hepatitis
陳弘益H. Y. Chen*
1臺南新樓醫院藥劑科
Ticlopidine 屬於抗血小板藥物,具不可逆抑制血小板凝集的作用,用於降低中風的風險。通常保留給不適合使用阿斯匹靈的病人或以阿斯匹靈治療失敗的病人,另一主要適應症是降低冠狀動脈支架病人的血栓併發症風險。可能副作用包括嗜中性白血球缺乏症(初期會產生發熱、喉嚨痛、疲倦感等症狀),血栓性血小板減少性紫斑,黃疸症狀,噁心、嘔吐、皮膚癢、變黃,以及食慾不振、胃不舒服等消化道症狀。本案例為84 歲女性,患有糖尿病、高血壓性心臟病,因為長期咳嗽、便秘、食慾不振、全身無力、容易疲勞、上腹部不適,皮膚發黃入院,生化檢查total-bilirubin 高達11.8 mg/dL,direct-bilirubin 高達7.0 mg/dL,aspartate aminotransferase (AST) 高達104 U/L、alanine aminotransferase (ALT) 高達96 U/L,疑似ticlopidine 導致膽汁鬱積型肝炎,停藥且服用silymarin 後total-bilirubin 逐漸降低。
 
Ticlopidine is an irreversible platelet aggregation inhibitor used to reduce the risk for thrombotic stroke.This drug is typically reserved for patients who are intolerant to aspirin, and for those whose aspirin therapy has failed. The other primary indication reduces the incidence of thrombotic complications in patients with coronary stents. The side effects have been associated with life-threatening hematologic disorders, including neutropenia (initial symptoms include fever, sore throat, and fatigue), thrombotic thrombocytopenic purpura,jaundice, nausea, vomiting, itching, yellow skin, poor appetite and stomach upset. This is a case of an 84-yearold woman with diabetes mellitus, hypertension induced heart disease. She was admitted to the hospital due to her long-term cough, constipation, poor appetite, weakness, easy fatigue, epigastric discomfort, and yellow skin. In biochemistry inspection, her total-bilirubin was 11.8 mg/dL, direct-bilirubin 7.0 mg/dL, aspartate aminotransferase (AST), 104 U/L and alanine aminotransferase (ALT) 96 U/L. Ticlopidine-induced cholestatic hepatitis was suspected. After stopping medications and taking silymarin, her total-bilirubin level decreased gradually.
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