心舒平與凱蒂心：適合所有心跳漏拍患者嗎？-神經內科

洪煒斌 醫師回覆-神經內科

醫事人員經歷： 衛生福利部臺南醫院 神經內科 特約主治醫師

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您好：
1, 2, 4.凱帝心（Diltiazem）和心舒平（Verapamil）在藥理學上來講都屬於鈣離子通道阻斷劑，一般是用來治療高血壓、緩解心搏過快。但是如果心跳比較慢，或是有心臟心房心室傳導阻滯的問題，就不建議服用。最好也不要和乙型交感神經阻斷劑同時服用。但是我沒有特別查到曾經罹患腦血管疾病就不能使用的資訊。以下是美國醫景（Medscape）的關於心舒平的使用禁忌症與需特別小心留意的患者。
Warnings
Contraindications
Hypersensitivity to verapamil or other calcium channel blockers
Cardiogenic shock
Congestive heart failure
Symptomatic hypotension
Sick sinus syndrome (unless permanent pacemaker in place)
2°/3° AV block (unless permanent pacemaker in place)

Cautions
Aortic stenosis
Atrial fibrillation/flutter with accessory bypass tract
1° AV block
Hypertrophic cardiomyopathy (eg, idiopathic hypertrophic subaortic stenosis)
Hypotension (initially or after dose increases)
Exacerbation of angina (during initiation of treatment, after dose increase, or after withdrawal of beta blocker)
Neuromuscular transmission defects; may exacerbate myasthenia gravis
Hepatic or renal impairment
Persistent progressive dermatologic reactions
Generic products may not be bioequivalent
Do not prescribe Covera-HS or Verelan PM for shift workers
Concurrent beta-blocker therapy
Concurrent ivabradine therapy
Slows AV conduction; use cautiously with beta blockers
Hypotension and bradyarrhythmias observed with concurrent use of other CYP3A4 substrates (eg, cyclosporine, telithromycin) because of competitive metabolism
Coadministration with CYP3A4 inhibitors (eg, erythromycin, itraconazole) may decrease metabolism and thus increase toxicity
Sinus bradycardia resulting in hospitalization and pacemaker insertion has been reported in association with concurrent use of clonidine with verapamil; monitor heart rate if coadministered
Verapamil is no longer part of Pediatric Advanced Life Support tachyarrhythmia algorithm
Potential toxic dose in patients <6 years old: 15 mg/kg

3.顱內血管狹窄通常要看狹窄的程度如何，若是狹窄程度嚴重，可以詢問是否需進行血管支架或是人工血管置換手術。但是目前這樣的侵襲性治療方式的好處與壞處仍然沒有明確的定論。因此目前仍舊建議常規使用抗血小板藥物（或是其他的抗凝血藥物），控制腦中風的危險因子（體重、高血壓、糖尿病、高血脂、戒菸等等）來減緩動脈硬化與斑塊形成的速度。至於是否需要進行追蹤，您可以和您的主治醫師討論。

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回覆日期：2020/03/11
資料來源：台灣e院 - 心舒平與凱蒂心