與Co-Diovan副作用有關之陣發性耳鳴加重及眩暈

Episodic Exacerbating Tinnitus and Vertigo Related to Side Effect of Co-Diovan

陳建志(Jiann-Jy Chen) ； 陳登郎(Dem-Lion Chen) ； 湯耀貿(Yao-Mao Tang)

《台灣耳鼻喉頭頸外科雜誌》 46卷2期 (2011/04) Pp. 87-91

https://doi.org/10.6286/2011.46.2.87

摘要

降血壓藥Co-Diovan的主要成分爲血管張力素受器拮抗劑valsartan，具有輕中度的副作用。一67歲男性，罹患兩側耳鳴已經多年，因高血壓服用Co-Diovan後發作陣發性耳鳴加重及眩暈1個月，求診於本院。搖頭測試呈現向左之眼振，換氣過度測試爲陽性，純音聽力檢查顯示左側聽閾較右側高。血管磁振造影顯示後顱窩循環之血管變異。爲免爭議，不建議更換Co-Diovan，遂額外給予抗血小板劑及腦循環促進劑。往後1個月，病症發作逐浙減少。往後l年，除了2次病患自行停藥後復發外，情況依然穩定。由於發病時之顱外頸部動脈超音波檢查與追蹤時相較，血管阻力較高，可能是血管張力素受器拮抗劑作用於腦血管的副作用，增加血管阻力，加上後顱窩循環之變異，引起陣發性的耳鳴加重及眩暈。

關鍵字

陣發性眩暈 ； 耳鳴 ； 椎動脈 ； 血管張力素受器拮抗劑

並列摘要

The major component of antihypertensive Co-Diovan is angiotensin receptor blocker (ARB), valsartan. Its side effects have been described as mild to moderate. A 67-year-old man has been bothered with bilateral tinnitus for many years. He presented with episodic exacerbating tinnitus and following vertigo for one month after taking Co-Diovan for hypertension. A head-shaking test showed left-forward spontaneous nystagmus. A hyperventilation test was positive. A pure tone audiometry showed the left hearing threshold was higher than the right. A magnetic resonance angiogram showed several vascular anomalies of posterior circulation. In order to prevent a legal misunderstanding, Co-Diovan was preserved; besides, an antiplatelet and a brain circulation promoter were recommended. Over the following month, the symptom recurred less and less. Over the following year, it was uneventful except twice recurrence when he halted the medication by himself. The extracranial neck color-coded duplex sonograms showed there is a higher vascular resistance in the event of symptom than follow-up; therefore, it should be the side effect of ARB that has acted on the cerebral vessels, increased cerebral vascular resistance, and incurred the episodic exacerbating tinnitus and following vertigo at the condition of posterior circulation anomaly.

並列關鍵字

episodic vertigo ； tinnitus ； vertebral artery ； angiotensin receptor blocker