Gamze BABÜR GÜLER, Ekrem GÜLER, Gültekin GÜNHAN DEMİR, Hacı Murat GÜNEŞ, Zeynep İşıl UĞURAD, Öykü ÖNAL MUSALLAR

Koroner Arter Hastalığı Olan Bir Hastada Beklenmedik Bir Hepatotoksisite ve Miyopati Nedeni: Statin Değil

Sertralin koroner arter hastalığına eşlik eden depresyon durumlarında etkinliğini ve güvenirliliğini kanıtlamış bir selektif serotonin geri alım inhibitörüdür. Sık görülen yan etkileri yanında (bulantı, ishal, dispepsi) daha nadir görülen (makülopati, hepatotoksisite, rabdomiyoliz) gibi yan etkileri de bildirilmiştir. Çoklu ilaç kullanımının sık olduğu hastalarda (kalp yetersizliği, koroner arter hastalığı gibi) depresyon tedavisinde sertralin kullanımına bağlı yan etkiler gözden kaçabilmektedir. Biz karaciğer fonksiyon testleri ve kas enzimleri yükselmiş bir koroner arter hastasında sertralinin; statinlerden sonra etyolojik ajan olarak değerlendirildiği ve bu sürede kreatinin kinaz, kreatinin kinaz-MB yüksekliği nedeniyle uzamış acil servis takipleri olan bir olguyu sunuyoruz.

Anahtar Kelimeler:

Koroner arter hastalığı, hepatotoksisite, miyopati, sertralin

An Unexpected Cause of Hepatotoxicity and Myopathy in A Patient with Coronary Artery Disease: It Is Not Statin

Sertraline is a selective serotonin reuptake inhibitor; it is safe and effective for treating depression in patients with coronary artery disease. Although nausea, diarrhea, and dyspepsia are common adverse effects, less frequent reactions such as maculopathy, hepatotoxicity, and rhabdomyolysis have also been reported. In patients receiving multiple drugs for co-morbid conditions (heart failure, coronary artery disease, etc.), these side effects can be underdiagnosed. Here, we present a patient with coronary artery disease and elevated liver function tests and skeletal muscle enzymes who had multiple admissions and prolonged follow-ups in the emergency room because of elevated creatine kinase and creatine kinase-MB levels, which delayed his appropriate management including discontinuation of sertraline instead of statin.

Keywords:

Coronary artery disease, hepatotoxicity, myopathy, sertraline,

PDF

___

1. Parissis J, Fountoulaki K, Paraskevaidis I, Kremastinos DT. Sertraline for the treatment of depression in coronary artery disease and heart failure. Expert Opin Pharmacother 2007;8:1529-37.
2. Sheline YI, Freedland KE, Carney RM. How safe are serotonin reuptake inhibitors for depression in patients with coronary heart disease? Am J Med 1997;102:54-9.
3. Shapiro PA, Lespérance F, Frasure-Smith N, O’Connor CM, Baker B, Jiang JW, et al. An open-label preliminary trial of sertraline for treatment of major depression after acute myocardial infarction (the SADHART trial): Sertraline Anti-Depressant Heart Attack Trial. Am Heart J 1999;137:1100-6.
4. Obach RS, Cox LM, Tremaine LM. Sertraline is metabolized by multiple cytochrome P450 enzymes, monoamine oxidases, and glucuronyl transferases in human: an in vitro study. Drug Metab Dispos 2005;33:262-70.
5. Lane RM. Pharmacokinetic drug interaction potential of selective serotonin reuptake inhibitors. Int Clin Psychopharmacol 1996;11(Suppl 5):s31-61.
6. Product Information. Zoloft (sertraline hydrochloride) US physician prescribing information. New York: Pfizer, 2012.
7. Fartoux-Heymann L, Hézode C, Zafrani ES, Dhumeaux D, Mallat. A Acute fatal hepatitis related to sertraline. J Hepatol 2001;35:683-4.
8. Chen S, Xuan J, Couch L, Iyer A, Wu Y, Li QZ, et al. Sertraline induces endoplasmic reticulum stress in hepatic cells. Toxicology 2014;322:78-88.
9. Chen S, Xuan J, Wan L, Lin H, Couch L, Mei N, et al. Sertraline, an antidepressant, induces apo-ptosis in hepatic cells through the mitogen-activated protein kinase pathway. Toxicol Sci 2014;137:404-15.
10. Gareri P, Segura-García C, De Fazio P, De Fazio S, De Sarro G. Sertraline-induced rhabdomyolysis in an elderly patient with dementia and comorbidities. Ann Pharmacother 2009;43:1354-9.

ISSN: 2149-2972
Yayın Aralığı: Yılda 3 Sayı
Başlangıç: 1990
Yayıncı: Sağlık Bilimleri Üniversitesi, Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi