他克莫司与伏立康唑联用致急性肾损伤  

Acute renal injury due to combination of tacrolimus and voriconazole

作　　者：杨新良 欧玮 谢小华 陈也君 Yang Xinliang;Ou Wei;Xie Xiaohua;Chen Yejun(Department of Pharmacy,Yueyang Central Hospital,Hunan Province,Yueyang 414000,China;Department of Pharmacy,Yueyang Maternal and Child Health Hospital,Hunan Province,Yueyang 414000,China)

机构地区：[1]岳阳市中心医院药学部,岳阳414000 [2]岳阳市妇幼保健院药剂科,岳阳414000

出　　处：《药物不良反应杂志》2023年第9期570-572,共3页Adverse Drug Reactions Journal

基　　金：岳阳市创新平台与人才计划重点实验室项目(岳市科发(2022)30号)。

摘　　要：1例73岁男性患者肺移植术后长期给予他克莫司2.5mg口服、2次/d,联合泼尼松5mg、1次/d抗排斥反应。因患者肺部烟曲霉感染,给予伏立康唑400mg口服、2次/d,次日调整为200mg、2次/d,期间患者继续抗排斥反应治疗。应用伏立康唑3d后患者出现尿量减少、乏力,血肌酐196μmol/L,他克莫司血药谷浓度49.0μg/L。考虑为他克莫司中毒导致的急性肾损伤。在监测血药浓度情况下,间断停用他克莫司3d,而后他克莫司减量至0.5mg、1次/d,伏立康唑减量至150mg、2次/d。17d后,患者24h尿量950ml,血肌酐154μmol/L,他克莫司血药谷浓度7.7μg/L。22d后,患者血肌酐下降至142μmol/L。考虑患者他克莫司血药谷浓度异常升高与联用伏立康唑后抑制其药物代谢有关。A 73-year-old male patient was treated with tacrolimus 2.5 mg twice daily combined with prednisone 5 mg once daily orally for anti-rejection after lung transplantation.Due to pulmonary aspergillus fumigatus infection,the patient received voriconazole 400 mg orally twice daily on the first day and then 200 mg twice daily from the next day.During this period,the patient continued to receive anti-rejection treatments.Three days after the application of voriconazole,the patient developed decreased urine output and fatigue,serum creatinine was 196μmol/L,and tacrolimus trough concentration was 49.0μg/L.Acute kidney injury caused by tacrolimus poisoning was considered.Under the monitoring of blood drug concentration,tacrolimus was discontinued intermittently for 3 days,then tacrolimus was reduced to 0.5 mg once daily and voriconazole was reduced to 150 mg twice daily.Seventeen days later,the patient had a 24-hour urine output of 950 ml,serum creatinine of 154μmol/L,and tacrolimus trough concentration of 7.7μg/L.Twenty-two days later,his serum creatinine decreased to 142μmol/L.It was considered that the abnormal increase of tacrolimus blood trough concentration was related to the inhibited metabolism after combined use with voriconazole.

关 键 词：药物相互作用 急性肾损伤 他克莫司 伏立康唑 细胞色素P450酶系统 

分 类 号：R969[医药卫生—药理学]