Oseltamivir引起嚴重心搏過慢：案例報告與文獻回顧

Oseltamivir-induced Severe Bradycardia: A Case Report and Literature Review

10.6168/FJCP.202401_32(1).0008

林志忠(Chih-Chung Lin)；宋惠琳(Hui-Lin Sung)；洪娟瑜(Chuan-Yu Hung)

Oseltamivir ； 心搏過慢 ； 流行性感冒 ； Oseltamivir ； Bradycardia ； Influenza

臺灣臨床藥學雜誌

32卷1期（2024 / 01 / 31）

85 - 93

繁體中文;英文

Oseltamivir為目前治療流行性感冒常用之口服抗病毒藥，其不良反應以噁心（8-10%）、嘔吐（2-8%）、頭痛（2-17%）或神經系統症狀（1%）為主。根據文獻回顧發現oseltamivir可能會引起心搏過慢之不良反應，其機轉可能與鈉、鉀與鈣離子通道的抑制作用有關。本案例為一名64歲女性因確診為A型流行性感冒而處方oseltamivir治療，隨後產生嚴重心搏過慢之藥物不良反應。醫療團隊發現後即停止使用oseltamivir並給予atropine與升壓劑治療。經過相關醫療介入後病人心跳恢復正常且順利出院。根據Naranjo score評估此藥物不良反應為7分，屬於「極有可能」。年紀大於58歲以上、有神經系統過去病史、流感病毒陽性或心跳速率區間為66-86 bpm的重症病人皆可能為導致此不良反應的危險因子。藉由本案例報告與文獻回顧，希望提醒藥師與臨床醫療人員oseltamivir治療期間應密切觀察病人心跳速率或其他生命徵象，藥師也應提醒醫療團隊oseltamivir為導致心搏過慢的可能風險因子，避免未及時察覺而增加後續醫療處置。

Oseltamivir is an orally administered antiviral medication commonly used to treat influenza, and the main adverse reactions include nausea (8-10%), vomiting (2-8%), headache (2-17%), or neurological symptoms (1%). Literature reviews indicate that oseltamivir can induce bradycardia, with known mechanisms suggesting a possible relationship with the inhibition of sodium, potassium, and calcium channels. Here, we present a case of a 64-year-old female suffering from influenza A who received oseltamivir and subsequently experienced severe bradycardia. Oseltamivir was held immediately, atropine and vasopressor were also administered to treat this adverse reaction. Following these interventions, the patient was stable with a normal heart rate and discharged thereafter. The calculated Naranjo score was 7 as probable possibility of this adverse event. Risk factors included that critically ill patients aged 58 years and above, a past history of neurological problems, confirmed influenza infection, or a heart rate ranging from 66 to 86 bpm. Based on this case report and literature review, we would like to remind pharmacists and clinical healthcare professionals to closely monitor heart rates and vital signs when prescribing oseltamivir to patients with influenza. Pharmacists should also take into account the potential risks and warn the medical team in order to avoid delay in diagnosis and minimize the complexity of subsequent medical interventions.