胺碘酮在临床用药中的药物相互作用研究  

The Research on Drug-Drug Interactions of Amiodarone in Clinical Administration

作　　者：任伟芳 吕小群 方忠宏 刘玉娟 Ren Weifang;Lv Xiaoqun;Fang Zhonghong;Liu Yujuan(Department of Pharmacy,Jinshan Hospital,Fudan University,Shanghai,201508)

机构地区：[1]复旦大学附属金山医院药剂科,上海201508

出　　处：《中国药事》2021年第9期1081-1086,共6页Chinese Pharmaceutical Affairs

基　　金：上海市临床药学重点专科建设项目(编号1229);复旦大学附属金山医院青年科研启动基金(编号JYQN-LC-202010)。

摘　　要：目的:通过对真实世界的胺碘酮药物相互作用的分析与评价,为临床合理用药提供参考。方法:收集2018年1月1日至2019年12月31日某院门急诊患者的胺碘酮处方,剔除用药总数<2种的处方,采用Lexicomp?、Stockley’s Drug Interactions以及药品说明书对其进行分析,评价药物相互作用的严重程度。结果:共收集到2987张胺碘酮相关的处方,筛选出与胺碘酮相关的DDIs的处方共2532张,占84.77%,与胺碘酮有关的DDIs数为4809种,其中X级94种,D级742种,C级3973种,以C级占比最多,为82.62%;美托洛尔、华法林和氟哌噻吨分别是引起胺碘酮C级、D级、X级DDIs最为常见的药物(12.31%、12.27%、1.66%),其不良结果主要有:(1)增加低血压风险,(2)增加华法林的血药浓度和抗凝作用,(3)增加QT间期延长风险。Logistic回归分析显示,合并用药种数与胺碘酮有关的DDIs的发生具有独立相关性(P<0.001)。合并用药种数≥5种与胺碘酮有关的DDIs的发生风险较合并用药种数2-4种高(OR 10.884,95%CI 6.821-17.365)。结论:胺碘酮与多种常用药物存在相互作用,多药合用是致胺碘酮DDIs的危险因素。重视与胺碘酮有关的DDIs风险,在处方前置审核系统中完善其DDIs的监测和预警,以避免潜在药源性损害的产生,提高医疗质量。Objective: To analyze and evaluate drug-drug interactions of amiodarone in the real-world and provide a reference for rational clinical use. Methods: Amiodarone prescriptions were collected from outpatients and emergency patients in a hospital from January 1, 2018 to December 31, 2019, and those with a total of fewer than two drugs were excluded. Lexicomp?, Stockley’s Drug Interactions and Drug instructions were applied to analyzing and evaluating the severity of drug-drug interactions. Results: 2987 prescriptions were screened for the presence of the DDIs related to amiodarone and 2532 prescriptions, accounting for 84.77%, containing 4809 DDIs related to amiodarone were identified. Among 4809 DDIs, grade X was 94, grade D 742 and C 3973,respectively. Grade C was 82.62% accounting for the largest proportion. Metoprolol, warfarin and flupenthixol are the most common drugs that cause grade C, grade D and grade X DDIs(12.31%, 12.27%, 1.66%) related to amiodarone, respectively. Their potential adverse effects mainly include increased risk of hypotension,increased blood concentration and anticoagulation of warfarin, and increased risk of prolonged QT interval.Logistic regression analysis shows that the number of drugs combinations was independently associated with the occurrence of Amiodarone-related DDIs(P<0.001). The number of prescription drugs≥5 had higher risk of developing DDIs compared with that of 2 to 4(OR 10.884, 95%CI 6.821-17.365). Conclusion: Amiodarone interacts with a variety of common drugs. Multi-drug combination is a risk factor for amiodarone-related DDIs.Attention should be paid to the risk of DDIs related to amiodarone, and the monitoring and forewarning of DDIs should be improved in the pre-prescription review system in order to avoid the potential drug-induced injury and improve the medical quality.

关 键 词：真实世界 胺碘酮 药物相互作用 处方前置审核 药源性损害 

分 类 号：R951[医药卫生—药学]