Midodrine 摘要 建佑醫院藥劑科藥師許永佳 張瓊月 (AASLD) midodrine midodrine refractory ascites diuretic-resistant ascites 壹 前言 81% 1 58% 50% 2 ( nitric oxide glucagon endothelin) - - (renin-angiotensin-aldosterone system, RAAS) 3 (shifting dullness flank dullness) (ultrasound) (CT scan) (MRI) (paracentesis) 2013 ( ) 4 (2 g/ day) spironolactone furosemide 100 mg: 40 mg ( 400 mg: 160 mg) non-steroidal anti-inflammatory drugs (NSAIDs) angiotensin converting enzyme inhibitors (ACEIs) angiotensin receptor blocker (ARBs) -blockers 10% (diuretic-resistant ascites) (refractory ascites) 30 4 Dec. 31 2014 藥學雜誌 121 91 臨床藥物治療學Midodrine 治療肝硬化合併腹水之案例
Therapeutics of Clinical Drugs 臨床藥物治療學 50% 25% 5 ( ) midodrine 4 midodrine 5 mg 24 2.5 mg/ dose 17.5 mg 4 表一肝硬化合併腹水之治療選擇 (sodium restriction) spironolactone furosemide (NSAIDs) -blockers ACEIs ARBs midodrine - (TIPS) 貳 案例報告 66 158 68 102 5 ( ) 102 7 20 (ovoid shape) (pitting edema 4+) 35.8 132 /min 19 /min 86/64 mmhg BUN 17 mg/ dl Cr 1.6 mg/dl GOT 51 U/L GPT 20 U/ L Na 125 meq/l K 3.2 meq/l Uric acid 9.7 mg/dl ( ) 7 20 spironolactone 25 mg/tab 3# QID + furosemide 20 mg/amp 1 amp Q8H + hydrochlorothiazide 50 mg/tab 1# BID 7 22 spironolactone 25 mg/tab 4# QID furosemide 20 mg/amp 2 amp Q8H 7 23 midodrine 2.5 mg/tab 2# TID 7 25 7 26 2# QID 3# QID (I/O ) -441 ml ~ -732 ml -1210 ml ~ -2192 ml ( ) (4+ 3+) 114 cm 103 cm 68 kg 57 kg ( ) 7 29 表二病人用藥紀錄 OPD UD / 5/14~6/03 7/20 7/21 7/22 7/23 7/24 7/25 7/26 7/27 7/28 7/29 A.M.Z 1# TID v Sennoside 12 mg/tab 2# HS v Roumin 5 mg/tab 1# TID v Dormicum 7.5 mg/tab 1# HS v Narcaricin 50 mg/cap 1# QD v 92 THE JOURNAL OF TAIWAN PHARMACY Vol.30 No.4 Dec. 31 2014
Midodrine OPD UD / 5/14~6/03 7/20 7/21 7/22 7/23 7/24 7/25 7/26 7/27 7/28 7/29 Spironolactone 25 mg/tab 2# QID v 3# QID 4# QID Gain-Vita (B-Complex) 1# BID v 1# TID Hydrochlorothiazide 50 mg/tab 1# BID v Furosemide 40 mg/tab 1# TID v Tamedin 200 mg/tab 1# QID Atinol 100 mg/tab 1/2# QD Furosemide 20 mg/amp 1 amp Q8H 2 amp Q8H Midodrine 2.5 mg/tab 2# TID 2# QID 3# QID 表三檢驗數據 7/20 7/26 WBC 4.0-10.1 10 3 /μl 7.52 5.86 RBC 4.0-6.0 10 3 /μl 3.11 2.66 Hb 12.9-17.0 g/dl 11 9.3 Ht 38.0-53.0 % 31.2 27.4 MCV 80.0-100.0 fl 100.3 103 MCH 27.0-32.0 pg 35 --- MCHC 31.0-36.0 g/dl 33.9 --- Platelet 150-400 10 3 /μl 254 197 BUN 8.0-22.0 mg/dl 17 41 Creatinine 0.5-1.3 mg/dl 1.6 4 Uric acid 2.1-7.3 mg/dl 9.7 --- GOP (AST) 3-38 U/L 51 24 GPT (ALT) 3-37 U/L 20 12 Albumin 3.5-5.1 g/dl 2.7 2.7 T-Bil 0.2-1.2 mg/dl 1 --- D-Bil 0-0.2 mg/dl 0.5 --- ALP 104-338 U/L 556 --- Cholesterol 110-220 mg/dl 94 --- TG 39-211 mg/dl 99 --- Na+ 135-153 meq/l 125 137 K+ 3.5-5.1 meq/l 3.2 3.2 Ammonia 9-47 μg/dl 59 --- 表四病人用藥後臨床評估 7/20 7/21 7/22 7/23 7/24 7/25 7/26 7/27 7/28 7/29 I/O (ml) -732-441 -640-1528 -1210-1468 -1282-2192 -190+loss --- 4+ 4+ 4+ 3+ 3+ 3+ 3+ 3+ 3+ 3+ (kg) 68.0 65.3 67.5 66.3 63.8 62.8 62.0 60.0 59.0 57.0 (cm) 114 106 110 108 108 110 109 104 105 103 86 100 89 66 74 90 94 77 83 103 (mmhg) 64 71 56 64 46 55 63 54 59 65 30 4 Dec. 31 2014
臨床藥Therapeutics of Clinical Drugs 物治療學圖一住院期間尿液排出量 (I/O 值 ) 變化參 討論 AASLD spironolactone furosemide (3.2 meq/l) furosemide furosemide / (125 meq/l) 120 meq/l (spironolactone 200-400 mg/day furosemide 60-120 mg/day) furosemide 6-9 102 4 furosemide furosemide 6 midodrine Singh V 7 20 ( ) midodrine midodrine (p < 0.05) midodrine (p = 0.013) midodrine midodrine (p < 0.046) 8 ( ) midodrine 7/23 midodrine 肆 結論 AASLD 94 THE JOURNAL OF TAIWAN PHARMACY Vol.30 No.4 Dec. 31 2014
Midodrine (peritoneovenous shunt) - (transjugular intrahepatic portosystemic shunt; TIPS) (liver transplantation) midodrine 臨床藥物治療住院期間血壓值變化 學圖二 Using Midodrine in A Patient with Cirrhosis and Ascites Yung-Chia Hsu, Chiung-Yueh Chang Department of Pharmacy, Chien-Yu Hospitol Abstract According to the guidelines of American Association for the Study of Liver Diseases (AASLD), patient with cirrhosis and ascites should abstain from alcohol, restrict sodium intake, and adopt combinational diuretics as first-line therapy. Second-line medications or surgical treatment are only considered for patients who develop resistance to diuretics or refractory ascites. Our case report concerns a patient with liver cirrhosis and severe ascites. Triple combination of diuretics was prescribed at the beginning of hospitalization. The patient showed poor response to these diuretics. Despite subsequent dose elevation of diuretics, no significant improvement was seen on patient s daily urination. After adding a second-line medication midodrine to the patient, his daily urination was markedly increased. Significant improvements on clinical manifestations, such as lower limbs edema, waistline and body weight, were also observed. 藥學雜誌 121 95 30 4 Dec. 31 2014
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