3种质子泵抑制药代谢性相互作用处方分析  

Prescription Analysis of Metabolic Interactions among Three Proton Pump Inhibitors

作　　者：沈斌[1] 张继明[1] 冯小敏[1] 沈水杰[2] 

机构地区：[1]浙江省嘉兴市第一医院药剂科,314000 [2]浙江大学药学院药分研究室,杭州310058

出　　处：《医药导报》2010年第1期109-111,共3页Herald of Medicine

摘　　要：目的了解质子泵抑制药(PPIs)的合并用药情况,为临床合理用药提供参考。方法以代谢酶学为指导,从代谢性相互作用角度对处方进行回顾性分析。结果3种PPIs的处方总量为2595张,其中合用CYP2C19或CYP3A4抑制药或底物的处方量分别为奥美拉唑118张,兰索拉唑42张,泮托拉唑116张,占PPIs处方总量的10.64%。克拉霉素、硝苯地平、多潘立酮和阿奇霉素在联合用药调查中出现的频率较高。结论与治疗窗较窄的底物,如苯妥英钠、华法林合用应注意奥美拉唑的剂量调整。泮托拉唑在代谢过程转硫基作用且和细胞色素P450依赖性酶的低亲和力,其与通过该酶系代谢的药物间的相互影响较小。药师在合并用药中应作好处方审查和患者用药教育,必要时对某些可疑相互作用进行血药浓度监测。Objective To investigate the combination usage of proton pump inhibitors （ PPIs）, providing information for proper clinical use of PPIs. Methods The retrospective analysis of drug interactions was conducted on a view of drug metabolism. Results 2 595 prescriptions were found containing three PPls, in which the amount of prescriptions coprescribed with CYP 2C19 or CYP3A4 substrates or inducers were 118, 42, and 116 for omeprazole, lansoprazole, and pantoprazole, respectively, accounting for 10.64% of total prescriptions of PPIs. Claritbromycin, nifedipine, domperidone and azithromycin appeared more frequently in this investigation. Conclusion When co-administrated with drugs with a narrow therapeutic window, such as phenytoin or warfarin, the dose of omeprazole should be adjusted. A sulfotransferase was involved in metabolism of pantoprazole and the affinity of pantoprazole to CYP P450 was low. Tberefore, pantoprazole has lower drug interaction potential with substrates or inducers of CYP 2C19 or CYP 3A4. Clinical pharmacists should devote to prescription checking and pharmaceutical service for patient on proper use of drugs. Monitor blood concentrations for suspected drug interactions, if necessary.

关 键 词：质子泵抑制药 药物代谢 相互作用 药物 处方分析 监测 血药浓度 

分 类 号：R969.3[医药卫生—药理学]