神经科专家提醒：头痛服用维拉帕米需警惕心律失常

Verapamil use for headache linked to cardiac dysrhythmia
头痛服用维拉帕米时需警惕心律失常痛服用维拉帕米需警惕心律失常

14 August 2007

MedWire News: Neurologists warn that the drug verapamil is associated with a high incidence of cardiac dysrhythmia in patients taking the drug to prevent cluster headache.
医药电讯:神经科专家警告说服用维拉帕米去预防丛集性头痛时心律失常发生率很高.

The team \"strongly recommends\" electrocardiogram (ECG) monitoring of all such patients to look for the development of atrioventricular block and symptomatic bradycardia.
研究小组强烈的推荐对所有患者心电图监护去寻找房室传导阻滞和心动过缓的症状.

Writing in the journal Neurology, Peter Goadsby (National Hospital for Neurology and Neurosurgery, London, UK, and University of California, San Francisco, USA) and colleagues explain that cluster headache is an excruciating primary headache syndrome.
神经科杂志写道, Peter Goadsby(神经科和神经外科的国立医院,伦敦,UK,加尼福尼亚大学, 圣弗兰西思科,美国)和同事解释说,丛集性头痛是头痛综合症中最痛苦的一种.

Verapamil seems to be effective in treating both episodic and chronic cluster headache, but at higher doses than those used in cardiologic indications. Mindful of the potential for cardiac complications with verapamil, Goadsby and team studied ECG changes in cluster headache patients treated with the drug at the National Hospital for Neurology and Neurosurgery.
维拉帕米在治疗间断发作和慢性丛集性头痛似乎是有效的;但用的剂量要比心脏病患者大. Goadsby和小组人员研究国立神经科和神经外科的药物治疗丛集性头痛的患者的心电图变化时注意到了维拉帕米潜在的心脏并发症.

The patients started verapamil at a dose of 240 mg daily, then at 2 weeks they had an ECG followed by an 80-mg increase in dose every 2 weeks and a check ECG until their cluster headache was suppressed, side effects intervened, or they reached a maximum daily dose of 960 mg. ,
患者开始每天服用240 mg维拉帕米，然后2周后观察心电图的变化,每两周增加80 mg且观察心电图的变化,直到头痛控制,控制副作用,或者达到每天960mg最大剂量.

Of 108 patients who had ECGs performed at the hospital, 21 (19%) had arrhythmias while taking verapamil at a mean dose of 567 mg daily. Thirteen (12%) had first-degree heart block (PR >0.2 seconds), with one requiring a permanent pacemaker.
108例住院患者做了心电图, 当每天服用平均剂量567 mg时21例(19%)患者,有心率失常;13(12%)例有I度房室传导阻滞((PR >0.2 秒);1例需要永久性起博器.

Nine (8%) patients had other arrhythmias, including
junction rhythm block (complete heart block) in four patients, second-degree heart block in one, and right bundle branch block in four patients.
9例(8%)患者并发其他心律失常:包括4例节律阻滞(完全心脏传导阻滞),1例II度房室传导阻滞,4例右束支传导阻滞.

Bradycardia (heart rate <60 beats per minute) was seen in 39 (36%) patients, but this was only severe enough to warrant cessation of verapamil in four cases.
39例(36%)患者心动过缓(心率<60次/分),但有4例比较严重需要停服维拉帕米.

In eight patients the PR interval lengthened with increasing verapamil doses, but to no greater than 0.2 seconds.
随着增加维拉帕米剂量,有8例患者PR间期延长,但是不超过0.2秒.

\"The benefit of taking verapamil to alleviate the devastating pain of cluster headaches has to be balanced against the risk of causing a heart abnormality that could progress into a more serious problem,\" said Goadsby.
Goadsby说:服用维拉帕米减轻丛集性头痛的好处抵消了心脏功能异常可能逐步发展为一个更为严重的问题.
Goadsby noted that 217 people taking the drug were initially enrolled in the study, but 42% did not undergo ECG monitoring.
Goadsby说,这项研究中有217服用药物的人登记,但42%的人没有实行心电监护.
\"Many of them said either they or their local services were reluctant to undertake such frequent tests, or they were not aware of the need for the heart monitoring,\" he said. \"Since this drug is relatively new for use in cluster headaches, it&#39;s possible that some health care providers are not aware of the problems that can come with its use.\"
“他们中的一些人说不情愿去做最后的测试,或者没有意识到心电监护的必要性”,他说,”既然这个药物对丛集性头痛来说相对是个新药,就可能还没有意识到伴随而来的问题”

Neurology 2007; 69: 668-675
编译551字). 头痛服用维拉帕米时需警惕心律失常
医药电讯:神经科专家警告说服用维拉帕米去预防丛集性头痛时心律失常发生率很高.( Neurology 2007; 69: 668-675 )
最近, 神经科杂志医药电讯栏目报道, Peter Goadsby(神经科和神经外科的国立医院,伦敦,UK,加尼福尼亚大学, 圣弗兰西思科,美国) 和同事谈到,丛集性头痛是头痛综合症中最痛苦的一种.他们在研究应用维拉帕米治疗偏头痛时发现, 维拉帕米在治疗间断发作和慢性丛集性头痛似乎是有效的;但用的剂量要比心脏病患者大. 而且Goadsby和小组人员研究国立神经科和神经外科的药物治疗丛集性头痛的患者的心电图变化时注意到了维拉帕米潜在的心脏并发症.
研究中总共有217例患者入选, 研究小组强烈的推荐对所有患者心电图监护去寻找房室传导阻滞和心动过缓的症状.但42%的人没有实行心电监护. “他们中的一些人说不情愿去做最后的测试,或者没有意识到心电监护的必要性”, Goadsby说,”既然这个药物对丛集性头痛来说相对是个新药,就可能还没有意识到伴随而来的问题”. 患者开始每天服用240 mg维拉帕米，然后2周后观察心电图的变化,每两周增加80 mg且观察心电图的变化,直到头痛控制,同时控制副作用;或者达到每天960mg最大剂量. 108例住院患者做了心电图, 当每天服用平均剂量567 mg时21例(19%)患者,有心率失常;13(12%)例有I度房室传导阻滞((PR >0.2 秒);1例需要永久性起博器. 39例(36%)患者心动过缓(心率<60次/分),但有4例比较严重需要停服维拉帕米.随着增加维拉帕米剂量,有8例患者PR间期延长,但是不超过0.2秒.
因此,他们警告说服用维拉帕米去预防丛集性头痛时心要警惕心律失常.”(