泊沙康唑对异体肾移植受者他克莫司血药浓度及肾功能的影响  

Effect of posaconazole on the blood concentration of tacrolimus and renal function in allograft renal transplant recipients

作　　者：吉莉娜 胡楠[1] 钱卿[1] JI Li-na;HU Nan;QIAN Qing(Department of Pharmacy,the First People’s Hospital of Changzhou,Changzhou Jiangsu 213003)

机构地区：[1]常州市第一人民医院药学部,江苏常州213003

出　　处：《中南药学》2023年第11期3068-3072,共5页Central South Pharmacy

基　　金：江苏省药学会-奥赛康医院药学基金项目(No.A202021);常州市科技基础设施建设计划-常州市临床药学重点实验室(No.CM20223005)。

摘　　要：目的探讨抗真菌药物泊沙康唑对肾移植受者他克莫司血药浓度的影响,为临床科学制订给药方案提供依据。方法回顾性收集同时接受他克莫司抗排异治疗和泊沙康唑口服混悬液抗真菌治疗的肾移植受者共计24例,统计受者合用泊沙康唑前与合用后1~14 d内不同时间段的他克莫司血药谷浓度(C0)、谷浓度剂量比(C0/D)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、血清肌酐(SCR)、血清尿酸(UA)等临床指标,比较两药合用前后他克莫司的剂量和浓度变化,以及受者的肝肾功能变化。结果肾移植受者合用泊沙康唑口服混悬液后,他克莫司的C0/D为合用前的3.13倍(P<0.05),他克莫司的给药剂量平均下降40.1%。在合用泊沙康唑后的4个时间段中,合用后8~10 d的C0/D上升最为显著,达3.30倍,他克莫司的给药剂量平均下降47.1%。合用泊沙康唑前后,患者肝肾功能无显著差异。结论临床合用泊沙康唑时,应预先降低他克莫司的给药剂量,但说明书建议的剂量调整方案不一定适用于所有受者,合用期间需密切监测他克莫司血药浓度并及时调整剂量,实现个体化用药。Objective To determine the effect of antifungal drug posaconazole on the blood concentration of tacrolimusin renal transplant recipients,and to provide reference for individualized therapy in clinical practice.Methods The clinical data of 24 renal transplant recipients who used tacrolimus and posaconazole were retrospectively analyzed.The concentrations of tacrolimus(C0),concentration/dose ratio(C0/D),alanine aminotransferase(ALT),aspartate aminotransferase(AST),serum creatinine(SCR)and uric acid(UA)of the recipients before and after(1~14 days)the co-administration of posaconazole were collected.The dose and concentration of tacrolimus were compared before and after the co-administration of both drugs,as well as the changes in the liver and kidney function of the recipients.Results The C0/D of tacrolimus after the co-administration of posaconzole was 3.13 times of before(P<0.05),while the average dose of tacrolimus decreased by 40.1%.In the four periods after the co-administration of posaconazole treatment,the C0/D at 8~10 days increased most significantly to 3.30 times,and the dose of tacrolimus decreased by 47.1%on average.There was not much difference in the liver and kidney function before and after the co-administration.Conclusion The dose of tacrolimus should be reduced before starting the co-administration of posaconazole in clinical practice.Recommended dose adjustment in the instructions may not be appropriate for all recipients.It is necessary to monitor the blood concentration of tacrolimus and adjust the dose timly in individualized therapy.

关 键 词：异体肾移植受者 泊沙康唑 他克莫司 浓度剂量比 

分 类 号：R979.5[医药卫生—药品]