最近剛好有位病人有嚴重的血小板減少症,結果他的藥單裡面有Zyvox。

如果用過Zyvox的人大概都會知道他有Thrombocytopenia的副作用,機轉在一篇期刊有提到:

文章在The Annals of Pharmacotherapy 

Mechanisms for Linezolid-Induced Anemia and Thrombocytopenia

摘錄如下: The thrombocytopenia is progressive and may require discontinuation of the drug; a mechanism for this effect has not been described. A bone marrow biopsy performed on a patient who developed thrombocytopenia 7 days after starting linezolid revealed adequate numbers of normal-appearing megakaryocytes. This finding alone argues against marrow suppression and supports an immune-mediated mechanism of platelet de-struction.C

所以有一些醫師就會建議病患使用vitamin B6來減緩這樣的副作用。

事實上,在一些關於zyvox的藥物介紹中,也可以看到一點蛛絲馬跡

 


In a study of patients with linezolid-associated thrombocytopenia, the administration of vitamin B6 was shown to help reverse the incidence of thrombocytopenia. Vitamin B6 was most effective when it was administered after linezolid treatment was held. Once hematologic levels were returned to baseline, concomitant administration of linezolid and vitamin B6 resulted in stable hemoglobin levels for the remainder of linezolid therapy.


Another study compared linezolid plus 50 mg vitamin B6 per day (n=31) with linezolid alone (n=62) administered to patients with cancer. This study concluded vitamin B6 was not beneficial in the prevention of leukopenia or thrombocytopenia, but found a possible trend towards the prevention of anemia.


如果你看維基百科,可以看到他在一連串的描述中,有提到這個案例:

A 2004 case report suggested that pyridoxine (a form of vitamin B6) could reverse the anemia and thrombocytopenia caused by linezolid,[71] but a later, larger study found no protective effect.[72]

裡面的reference71和72,名稱為:

  1. Spellberg B, Yoo T, Bayer AS (October 2004). "Reversal of linezolid-associated cytopenias, but not peripheral neuropathy, by administration of vitamin B6". Journal of Antimicrobial Chemotherapy 54 (4): 832–5. doi:10.1093/jac/dkh405PMID 15317746.
  2. Plachouras D, Giannitsioti E, Athanassia S, et al. (2006). "No effect of pyridoxine on the incidence of myelosuppression during prolonged linezolid treatment". Clinical Infectious Diseases43 (9): e89–91. doi:10.1086/508280.


如果有需要原始檔的,請偷偷下載

所以這樣做真的有效嗎?感覺上好像只是幾次的臨床案例而已。

如果你還有興趣,建議妳可以找:

1.Journal of Antimicrobial Chemotherapy (2008) 61, 421–424

   標題為:The role of vitamin B6 in the prevention of haematological toxic effects of linezolid in patients with cancer

2.Ann Pharmacother 2003;37:517-20.
   標題為:Mechanisms for Linezolid-Induced Anemia and Thrombocytopenia

 

這裡面都會有提到關於vitamin B6的用途


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