超剂量口服伏立康唑致血药浓度升高和肝损伤  

Elevated blood concentration and liver injury due to oral administration of overdose voriconazole

作　　者：高杰[1] 陈蕊欢 郑晓娴[1] Gao Jie;Chen Ruihuan;Zheng Xiaoxian(Department of Pharmacy,the First Affiliated Hospital of Soochow University,Jiangsu Province,Suzhou 215006,China;Department of Pharmacy,Changshu First People's Hospital,Jiangsu Province,Changshu 215500,China)

机构地区：[1]苏州大学附属第一医院药学部,215006 [2]江苏省常熟市第一人民医院药剂科,215500

出　　处：《药物不良反应杂志》2019年第6期441-442,共2页Adverse Drug Reactions Journal

摘　　要：1例51岁女性淋巴瘤患者化疗后出现中性粒细胞缺乏伴发热,医嘱予伏立康唑1.0 g口服,2次/d(说明书推荐剂量为0.2~0.4 g口服、2次/d)。患者24 h内服用伏立康唑3次共3.0 g。后经药师提醒发现用药错误,停用伏立康唑。停药12、24、36和48 h伏立康唑血药浓度分别为12.20、10.20、6.55和4.45 mg/L。患者用药前血清丙氨酸转氨酶(ALT)11 U/L,天冬氨酸转氨酶(AST)6 U/L,γ-谷氨酰转肽酶(γ-GT)44 U/L。停药2 d复查,ALT 327 U/L,AST 153 U/L,γ-GT 627 U/L,考虑为超剂量服用伏立康唑导致的肝损伤。予静脉滴注复方甘草酸苷注射液和口服双环醇保肝治疗。停药3 d,患者伏立康唑血药浓度为0.67 mg/L,ALT 191 U/L,AST 31 U/L,γ-GT 522 U/L。停药16 d,患者ALT 24 U/L,AST 15 U/L,γ-GT 224 U/L。A 51-year-old female patient with lymphadenoma developed neutrophil deficiency with fever after chemotherapy.Voriconazole 1.0 g twice daily was given orally following the doctor’s advice(the recommended dose by drug label is 0.2-0.4g twice daily).the patient took voriconazole 3 times with total dose of 3.0 g within 24 hours.The medication error was found by a pharmacist and voriconazole was stopped.The voriconazole blood concentrations after 12,24,36,and 48 hours of drug withdrawal were 12.20,10.20,6.55,and 4.45 mg/L,respectively.The laboratory tests showed alanine aminotransferase(ALT)11 U/L,aspartate aminotransferase(AST)6 U/L,andγ-glutamyl transpeptidase(γ-GT)44 U/L before medication and ALT 327 U/L,AST 153 U/L,andγ-GT 627 U/L after 2 days of drug withdrawal,respectively.Overdose of voriconazole-induced liver injury were considered.The patient received the liver-protective therapy including an IV infusion of compound glycyrrhizin injection and oral bicyclol.After 3 days of drug withdrawal,the voriconazole blood concentration was 0.67 mg/L and the laboratory tests showed ALT 191 U/L,AST 31 U/L,andγ-GT 522 U/L.After 16 days of drug withdrawal,the laboratory tests showed 24 U/L,15 U/L,and 224 U/L,respectively.

关 键 词：伏立康唑 用药错误 药物监测 化学药物性肝损伤 

分 类 号：R[医药卫生]