泊沙康唑对免疫抑制药药代动力学影响的评价  

Review of posaconazole on pharmacokinetic impact of immunosuppressors

作　　者：王红梅[1] 陈恳[2] 胡凯[3] 刘维[2] 

机构地区：[1]北京大学第三医院延庆医院、北京市延庆区医院药剂科,北京102100 [2]北京大学第三医院药剂科,北京100191 [3]北京大学第三医院血液科,北京100191

出　　处：《中国临床药理学杂志》2018年第1期57-59,共3页The Chinese Journal of Clinical Pharmacology

摘　　要：目的系统评价泊沙康唑对免疫抑制药药代动力学的影响。方法检索PubMed,EmBase,Cochrane Library,Clinicaltrials.gov,中国知网,万方和中国生物医学文献数据库,纳入比较免疫抑制药联用泊沙康唑前后药代动力学变化的随机对照试验和观察性研究,必要时用RevMan 5.3软件对免疫抑制药药代动力学指标进行Meta分析。结果纳入7篇研究,共258例患者。其中,环孢素2篇共45例患者,他克莫司3篇共62例患者,西罗莫司4篇共151例患者。研究总体质量较差。泊沙康唑与环孢素合用后,环孢素的血药浓度/剂量(C/D)、AUC、C_(max)、t_(1/2)分别是合用前的1.38,1.33,1.05,1.21倍;泊沙康唑与他克莫司合用后,他克莫司C/D,AUC,C_(max),t_(1/2)分别是合用前的3.29,4.23,2.14,1.24倍;泊沙康唑与西罗莫司合用后,西罗莫司C/D,AUC,C_(max),t_(1/2)分别是合用前的2.71,8.34,6.37,1.52倍。结论泊沙康唑影响环孢素、他克莫司、西罗莫司的药代动力学参数,为保持有效并安全的血药浓度,合用时,需根据血药浓度减少免疫抑制药的日剂量。Objective To evaluate pharmacokinetic impact of posaconazole on immunosuppressors. Methods PubMed,EmBase,Cochrane Library,Clinicaltrials. gov,CNKI,Wanfang data and CBM were systematica-lly searched. Randomized controlled trials and observational studies which compared combinational use of immunosuppressors and posaconazole were collected. If necessary,Meta-analysis about pharmacokinetic characters of immunosuppressors were performed with RevMan 5. 3 software. Results Totally 7 studies were included,involving 258 patients.Two studies of them involving 45 patients related to cyclosporine,3 studies involving 62 patients were using tacrolimus,and 4 studies of 151 patients studied sirolimus,respectively. Overall quality of included studies was low. Concentration/dosage ratio（ C/D）,AUC,C_（max） and t_（1/2） of cyclosporine when combined with posaconazole were 1. 38-fold,1. 33-fold,1. 05-fold and 1. 21-fold increase when compared with cyclosporine A monotherapy. C/D,AUC,C_（max） and t_（1/2） of tacrolimus were 3. 29-fold,4. 23-fold,2. 14-fold and 1. 24-fold increase compared with monotherapy. C/D,AUC,C_（max） and t_（1/2） of sirolimus were2. 71-fold,8. 34-fold,6. 37-fold and 1. 52-fold increase compared with monotherapy. Conclusion Pharmacokinetics of immunosuppressors were changed when combined with posaconazole,therefore dosage should be adjusted according to therapeutic drug monitoring.

关 键 词：泊沙康唑 药物相互作用 环孢素 他克莫司 西罗莫司 

分 类 号：R978.5[医药卫生—药品]