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1、416药物不良反应杂志2009年12月第11卷第6期ADRJ,December2009,Vol11.No.6安全用药甘草及甘草酸制剂引起的假性醛固酮增多症及防治刘然(北京积水潭医院药剂科,北京100035)摘要甘草是常用中药,主要含有甘草甜素(甘草酸)、甘草次酸及黄酮类化合物。大剂量或长期使用甘草或甘草酸,可引起假性醛固酮增多症,临床表现为血压升高、心悸、气短、心律失常、嗜睡、全身乏力、四肢麻痹、低血钾、下肢和全身水肿等。老年人、妇女、心血管疾病和肾损害者易发生此症。甘草及甘草酸制剂引起的假性
2、醛固酮增多症和抑制11氢化类固醇脱氢酶及增加盐皮质激素受体活性有关。防治措施包括:甘草及甘草酸制剂不宜大剂量或长期使用;老年人、心血管疾病和肾脏疾病、高血压、糖尿病患者应慎用;尽量避免与强心苷、利尿剂等合用;用药期间应定期检查血清钾值和测定血压;一旦发生假性醛固酮增多症,应立即停药;重症患者适当补充钾盐,口服氨苯蝶啶,给予低钠饮食等。关键词甘草;甘草酸;假性醛固酮增多症;防治中图分类号:R979文献标识码:A文章编号:10085734(2009)4041604Licoriceandgly
3、cyrrhizinicacidpreparationinducedpseudohyperaldosteronism:preventionandtreatmentLiuRan(DepartmentofPharmacy,BeijingJishuitanHospital,Beijing100035,China)ABSTRACTLicoriceisacommonlyusedtraditionalChinesemedicinewhichmainlycontainsglycyrrhizin(glycyrrhizinicac
4、id),glycyrrhetinicacid,andflavonoid.Largedosageorlongtermuseoflicoriceorglycyrrhizinicacidmaycausepesudohyperaldosteronism.Clinicalpresentationsareincreasedbloodpressure,palpitation,shortnessofbreath,arrhythmia,somnolence,generalisedasthenia,tetraplegia,hypok
5、alemia,lowerlimbandsystemicedema,etc.Thesubjectspronetodevelopingpseudohyperaldoteronismincludetheelderly,women,andthosewithcardiovasculardiseaseorrenalimpairment.Themechanismofpseudohyperaldoteronismfromlicoriceorglycyrrhizinicacidisassociatedwithinhibitionof1
6、1betahydroxysteroiddehydrogenaseandincreasedactivationofmineralocorticoidreceptors.Themeasuresofpreventionandtreatmentareasfollows:largedosageandlongtermuseoflicoriceorglycyrrhizinicacidshouldbeavoid;thedrugshouldbeusedverycarefullyintheelderly,thepatientswi
7、thcardiovasculardisease,renaldisease,hypertension,anddiabetesmellitus;licoriceorglycyrrhizinicacidincombinationwithcardiacglycosideordiureticsshouldbeavoided;serumpotassiumlevelshouldbemeasuredandbloodpressureshouldbemonitoredregularlyduringdrugtherapy;oncepseu
8、dohyperaldosteronismoccurs,thedrugshouldbestopped;patientswithseveresymptomsshouldbeadministeredanappropriatepotassiumsupplement,oraltriamterence,andalowsodiumdiet.KEYWORDS
