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药物相互作用是临床常见的问题,据报道合并用药越多,发生相互作用的机会就增多,药物不良反应的发生率就越高.用药6～10种,药物不良反应发生率为10%,用药16～20种则发生率上升至54%.[病例1]男,75y.患慢性肝病,血糖偏高,空腹血糖10～12mmol/L,po格列本脲2.5mg tid,1mo后因心率较快而加用普萘洛尔10mg tid,1wk后患者突然昏迷,测血糖仅0.11mmol/L.普萘洛尔为β-受体阻滞剂,可抑制糖酵解及胰高糖素的分泌而增强降糖药的降血糖作用.在生理状态下,血糖下降时β受体兴奋,肝糖原和肌糖原分解而得以补充.应用降糖药同时并用普萘洛尔,抑制β受体导致血糖过低.除此之外,普萘洛尔可掩盖低血糖的某些表现,如心动过速、出汗等,不利于临床及时发现,故临床上应警惕β-受体阻滞剂与降糖药合用,可引起急性严重低血糖反应.
Drug interactions are common clinical problems, the more drug combinations reported, the more opportunities for interaction and the higher the incidence of adverse drug reactions. 6 to 10 drugs, 10% adverse drug reactions, medication 16 to 20 species the incidence rose to 54%. [Case 1] Male, 75y. Chronic liver disease, high blood glucose, fasting blood glucose 10 ~ 12mmol / L, po glyburide 2.5mg tid, 1mo heart rate after more Fast and add propranolol 10mg tid, 1wk after a sudden coma, measured blood glucose was only 0.11mmol / L. Propranolol is a beta-blocker that can inhibit glycolysis and glucagon secretion And enhance the hypoglycemic effect of hypoglycemic agents in the physiological state, the decline in blood glucose β receptor excitability, liver glycogen and muscle glycogenolysis and to be supplemented.Apply hypoglycemic agents at the same time with propranolol, β receptor inhibition Leading to hypoglycemia.In addition, propranolol can mask some of the performance of hypoglycemia, such as tachycardia, sweating, etc., is not conducive to clinical timely detection, it should be vigilant clinically β-blockers Combined with hypoglycemic agents, can cause acute severe hypoglycemia.