1例伏立康唑联用奥美拉唑致双上肢震颤药学监护  

Pharmaceutical Care of Bilateral Upper Limb Tremor Induced by Voriconazole Combined with Omeprazole:A Case Report

作　　者：赵欢欢 宋佳伟 张鹏程 陈慧娟[1] 刘丽 ZHAO Huanhuan;SONG Jiawei;ZHANG Pengcheng;CHEN Huijuan;LIU Li(The People's Hospital of Bozhou,Bozhou,Anhui,China 236800)

机构地区：[1]安徽省亳州市人民医院,安徽亳州236800

出　　处：《中国药业》2023年第3期120-123,共4页China Pharmaceuticals

摘　　要：目的探讨临床药师开展药学服务的方法及思路。方法临床药师参与1例伏立康唑联用奥美拉唑致双上肢震颤药品不良反应(ADR)的多学科会诊(MDT),采用诺氏评估量表和药物相互作用可能性量表(DIPS)对可疑药物进行评估。结果三氧化二砷既往和再次使用未出现双上肢震颤,经MDT专家组讨论予以排除。伏立康唑与奥美拉唑的DIPS总分为5分,评估结果为“可能”。患者出现双上肢震颤的原因可能为奥美拉唑影响伏立康唑代谢,导致伏立康唑血药谷浓度过高。结论临床药师可利用药物代谢动力学知识,协助医师制订和优化治疗方案,促进临床合理应用伏立康唑,确保患者用药安全。Objective To investigate the methods and ideas of clinical pharmacists to carry out the pharmaceutical care.Methods Clinical pharmacists participated in the multidisciplinary consultation(MDT)of a case with the adverse drug reactions(ADR)of bilateral upper limb tremor induced by voriconazole combined with omeprazole,and evaluated the suspicious drugs by the Naranjo's ADR probability scale(APS)and the Drug Interaction Probability Scale(DIPS).Results Arsenic trioxide did not induce the bilateral upper limb tremor in the past and after the re-use,which was ruled out after the discussion by the MDT expert group.The total DIPS score of voriconazole and omeprazole was five points,with the evaluation result of"possible".The reason for the bilateral upper limb tremor in patients may be that omeprazole affected the metabolism of voriconazole,resulting in the high mininum-concentration of voriconazole.Conclusion Clinical pharmacists can use the knowledge of pharmacokinetics to assist physicians in formulating and optimizing treatment schemes,promote the rational use of voriconazole,and ensure the safe drug use for patients.

关 键 词：伏立康唑 奥美拉唑 双上肢震颤 药物相互作用 药品不良反应 药学监护 

分 类 号：R95[医药卫生—药学] R978.5