利福布汀影响伏立康唑血药浓度1例并文献复习  

Effect of Rifabutin on Voriconazole Concentration in Plasma:a Report of One Case and Literature Review

作　　者：林志强[1] 吴水发 陈婷婷[1] LIN Zhi-qiang;WU Shui-fa;CHEN Ting-ting(Department of Pharmacy,Quanzhou First Hospital Affiliated to Fujian Medical University,Quanzhou 362000,China)

机构地区：[1]福建医科大学附属泉州第一医院药剂科,福建泉州362000

出　　处：《海峡药学》2023年第10期41-44,共4页Strait Pharmaceutical Journal

基　　金：泉州市科技计划资助,2021年泉州市人才领域科研项目(项目编号:2021C036R)。

摘　　要：目的了解联合应用利福布汀对伏立康唑血药浓度的影响。方法对我院1例利福布汀、异烟肼等抗结核药与伏立康唑联合应用,伏立康唑的血药浓度进行分析,并以“伏立康唑”、“利福布汀”为主题词检索万方、维普和中国知网数据库,以“Voriconazole”、“Rifabutin”为主题词检索Pubmed数据库,检索国内外报道的利福布汀影响伏立康唑血药浓度的病例,筛选并总结分析病例资料。结果本院报道的病例中,患者联合使用利福布汀0.3 g,1日1次和伏立康唑200 mg,1日2次,4个月,结果伏立康唑的血药浓度为0.00μg·mL^(-1)。文献检索到2例案例报道,利福布汀可诱导伏立康唑的体内代谢,但在治疗浓度监测下进行治疗方案调整,可达到有效浓度。结论利福布汀对细胞色素P-450酶(CYP450)的诱导作用低于利福平,与伏立康唑合用时,需要在治疗药物监测下,调整伏立康唑给药方案;同时伏立康唑通过抑制CYP3A4,可增加利福布汀稳态峰浓度(C_(max))和药-时曲线下面积(AUC),需要密切监测患者的全血细胞计数和与利福布汀有关的不良反应。OBJECTIVE To investigate the effect of combined application of rifabutin on the plasma concentration of voriconazole.METHODS To analyze the voriconazole plasma concentration in one patient in our hospital who used rifabutin,isoniazid and other anti-tuberculosis drugs in combination with voriconazole.Wanfang,VIP,CNKI and Pubmed databases were searched with“voriconazole”and“rifabutin”as the key words.The cases reported at home and abroad that rifabutin affected the blood drug concentration of voriconazole were retrieved,screend and summarized the case data.RESULTS In the case reported in our hospital,the patient received the combination of rifambutin 0.3 g once a day and voriconazole 200 mg twice a day for 4 months,and the blood concentration of voriconazole was 0.00μg·mL^(-1).Two cases were reported in literature,rifambutin could induce voriconazole metabolism in vivo,but the effective concentration could be achieved by adjusting the treatment regimen under the therapeutic drug monitoring.CONCLUSION The induction effect of rifambutin on CYP450 is lower than that of rifampicin.When used in combination with voriconazole,the administration schedule of voriconazole needs to be adjusted under the therapeutic drug monitoring.Meanwhile,voriconazole can increase the steady-state C_(max) and AUC of rifabutin by inhibiting CYP3A4.It is necessary to closely monitor the whole blood cell count and adverse reactions related to rifabutin.

关 键 词：伏立康唑 利福布汀 治疗药物监测 血药浓度 药物相互作用 

分 类 号：R969.1[医药卫生—药理学]