药物引起的心脏毒性是药物开发和临床实践中的主要关注点。尽管心脏不是药物不良反应的常见目标，但一些药物仍然会引起各种心脏不良事件，有时会造成严重后果。直接心脏毒性包括由于可能接触药物而导致的心血管系统的功能和结构变化。这种现象不仅限于心血管药物，还包括非心血管药物，包括酪氨酸激酶抑制剂、蒽环类药物和免疫检查点抑制剂（ICIs）等抗癌药物，以及各种抗精神病药物、文拉法辛，甚至一些抗生素（如大环内酯类药物）。心脏不良反应包括一系列影响，从心力衰竭和心肌缺血到瓣膜疾病、血栓形成、心肌炎、心包炎、心律失常和传导异常。潜在的机制可能包括离子过程的干扰、线粒体功能受损诱导细胞损伤，甚至高凝状态。为了减轻药物引起的心脏毒性的影响，根据国际人用药品技术要求协调委员会 (ICH) 体外和体内测试指南，制定了多阶段评估指南。尽管有临床前保障措施，但上市后监测仍然至关重要，因为某些心脏毒性药物可能会逃避初步审查。事实上，历史数据显示，心血管药物不良反应占市场撤出量的近 10%。药物引起的心脏毒性对心脏问题，特别是心力衰竭的影响常常被低估，其发生率从 11.0% 到 20.0% 以上不等。我们在此全面研究药物引起的心脏毒性的不同模式，强调当前的担忧和新出现的药物警戒信号。了解潜在机制和相关风险因素对于及时识别、有效管理和主动预防药物引起的心脏不良事件至关重要。医生和心脏病专家之间的合作，加上全面的评估和密切监测，对于确保患者在面临潜在的药物引起的心脏毒性时的安全至关重要。版权所有 © 2023 Société française de druglogie et de thérapeutique。由 Elsevier Masson SAS 出版。版权所有。

Drug-induced cardiotoxicity is a primary concern in both drug development and clinical practice. Although the heart is not a common target for adverse drug reactions, some drugs still cause various adverse cardiac events, with sometimes severe consequences. Direct cardiac toxicity encompasses functional and structural changes of the cardiovascular system due to possible exposure to medicines. This phenomenon extends beyond cardiovascular drugs to include non-cardiovascular drugs including anticancer drugs such as tyrosine kinase inhibitors, anthracyclines and immune checkpoint inhibitors (ICIs), as well as various antipsychotics, venlafaxine, and even some antibiotics (such as macrolides). Cardiac ADRs comprise an array of effects, ranging from heart failure and myocardial ischemia to valvular disease, thrombosis, myocarditis, pericarditis, arrhythmias, and conduction abnormalities. The underlying mechanisms may include disturbances of ionic processes, induction of cellular damage via impaired mitochondrial function, and even hypercoagulability. To mitigate the impact of drug-induced cardiotoxicity, multi-stage evaluation guidelines have been established, following the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) guidelines for in vitro and in vivo testing. Despite preclinical safeguards, post-marketing surveillance remains critical, as certain cardiotoxic drugs may escape initial scrutiny. Indeed, historical data show that cardiovascular ADRs contribute to almost 10% of market withdrawals. The impact of drug-induced cardiotoxicity on cardiac issues, particularly heart failure, is often underestimated, with incidence rates ranging from 11.0% to over 20.0%. We here comprehensively examine different patterns of drug-induced cardiotoxicity, highlighting current concerns and emerging pharmacovigilance signals. Understanding the underlying mechanisms and the associated risk factors is critical in order to promptly identify, effectively manage, and proactively prevent drug-induced cardiac adverse events. Collaborative efforts between physicians and cardiologists, coupled with thorough assessment and close monitoring, are essential to ensuring patient safety in the face of potential drug-induced cardiotoxicity.Copyright © 2023 Société française de pharmacologie et de thérapeutique. Published by Elsevier Masson SAS. All rights reserved.