基于治疗药物监测干预伏立康唑药物相互作用并文献复习  

Case report and literature review of drug-drug interactions intervened by therapeutic drug monitoring for voriconazole

作　　者：王鸣璐 孙亚欣[1] 徐英宏[1] WANG Ming-lu;SUN Ya-xin;XU Ying-hong(Department of Pharmacy,Shengjing Hospital of China Medical University,Shenyang 110004,China)

机构地区：[1]中国医科大学附属盛京医院药学部

出　　处：《实用药物与临床》2019年第12期1253-1257,共5页Practical Pharmacy and Clinical Remedies

摘　　要：目的通过对1例肺曲霉菌病合并活动性结核患者应用伏立康唑与利福平的监护与干预,探讨临床药师基于治疗药物监测(TDM)在识别药物相互作用中发挥的作用。方法临床药师利用治疗药物监测作为技术支持,分析与利福平联用前、后的伏立康唑血药浓度变化情况,揭示二者相互作用的严重程度及持续时间,寻找替代治疗方案。结果伏立康唑与利福平联用7 d后,血药浓度较单用基线值下降了88.28%,停用利福平后第3天血药浓度开始回升,停用第10天后血药浓度上升至有效浓度范围内,但仍未恢复至基线水平。结论利福平可显著降低伏立康唑血药浓度,且作用时间持久,应避免合用。Objective To explore the role of clinical pharmacist in identifying drug-drug interactions based on therapeutic drug monitoring(TDM)by intervention of the combination use of voriconazole and rifampicin in a patient with pulmonary aspergillosis and active tuberculosis.Methods Clinical pharmacists used therapeutic drug monitoring as a technical support to analyze the changes of the serum concentration of voriconazole before and after combination use of voriconazole and rifampin,in order to reveal the severity and duration of the interaction and recommend alternative regimens.Results After 7 days of combined medication,the serum concentration of voriconazole decreased by 88.28%compared with the baseline value.The serum concentration of voriconazole began to rise on the third day after withdrawal of rifampin,and it was within the effective concentration range after 10 days,but still did not rise to the baseline.Conclusion Rifampicin can significantly reduce the serum concentrations of voriconazole and has a prolonged duration of action,so the combination of voriconazole and rifampicin should be avoided in clinical practice.

关 键 词：治疗药物监测 药物相互作用 伏立康唑 利福平 

分 类 号：R96[医药卫生—药理学]