Author/Editor		Zver, Samo; Dovšak, Tadej
Title		Paralitični ileus kot zaplet zdravljenja z vinkristinom in itrakonazolom
Translated title		Paralytic ileus as a side effect of vincristine and itraconazole treatment
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 72, št. 9
Publication year		2003
Volume		str. 499-501
Language		slo
Abstract		Background. Vincristin is an important and frequently used chemoterapeutic drug in the treatment of malignant lymphoproliferative disease. Among its side effects are well known bone marrow supression and polyneuropathia. But common physicians are not familiar with vincristine bowel peristaltics inhibitory effect. Patient and methods. This study presents 64 years old patient with acute lymphoblastic leukemia (ALL) who was treated with chemotherapy which included vincristine. Two weeks after the treatment started paralytic ileus developed which was later sucessfully treated with laxatives and prokynetic drugs. Secondary causes for ileus development were excluded. Literature data was reviewed and a higher incidence of paralytic ileus in vincristine treated patients was found, especially when they are given concomitant itraconazole. Our patient received concommitant itraconazole as a part of antifungal prophylaxis against invasive aspergillosis which is a perceived routine on hematological departments. Conclusions. Vincristine treated patients should be carefully observed regarding bowel peristaltics and obstipation. If obstipation or even paralytic ileus developes, we must stop vincristine therapy. All patients receiving vincristine must receive fluconazol instead of itraconazol as a part of antifungal prophylaxis.
Summary		Izhodišča. Vinkristin je nepogrešljiv citostatik pri zdravljenju malignih limfoproliferativnih bolezni. Med stranskimi učinki zdravila sta dobro poznana njegov zaviralni učinek na kostni mozeg in polinevropatija. Navadno pa lečeči zdravniki prezremo njegov zaviralni učinek na črevesno peristaltiko. Bolnik in metode. Predstavljen je 64-letni bolnik z akutno limfoblastno levkemijo (ALL), zdravljen s kombinirano kemoterapijo, ki je vključevala tudi vinkristin. Dva tedna po začetku zdravljenja je prišlo do nastanka paralitičnega ileusa, ki se je razrešil po dolgotrajnem zdravljenju z odvajali in prokinetiki. S preiskavami smo izključili sekundarni vzrok za nastanek ileusa. Ob pregledu literature smo ugotovili, da je incidenca paralitičnega ileusa pri bolnikih, zdravljenih z vinkristinom, še posebej visoka, če hkrati prejemajo tudi itrakonazol. Tudi v našem primeru je bolnik prejemal itrakonazol, ki ga na hematoloških oddelkih pogosto uporabljamo za preprečevanje glivičnih okužb, predvsem invazivne aspergiloze. Zaključki. Pri bolnikih, ki prejemajo vinkristin, moramo biti pozorni na pojav zaprtja. Če se pojavi zaprtje ali pa pride celo do nastanka paralitičnega ileusa, potem moramo prenehati zdraviti z vinkristinom. Vsi bolniki, ki prejemajo vinkristin, naj kot protiglivično preventivno zdravljenje prejemajo flukonazol in ne itrakonazol
Descriptors		LEUKEMIA, LYMPHOCYTIC, ACUTE VINCRISTINE ITRACONAZOLE INTESTINAL PSEUDO-OBSTRUCTION MIDDLE AGE