复方新诺明致高血钾不良反应的药学管理  

Pharmaceutical management of sulfamethoxazole/trimethoprim-induced hyperkalemia

作　　者：张春娟 赵蕊[2] 周昔程 Zhang Chunjuan;Zhao Rui;Zhou Xicheng(Department of Pharmacy,Haiyan People's Hospital,Haiyan 314300,China;Department of Pharmacy,Sir Run Run Shaw Hospital,College of Medicine,Zhejiang University,Hangzhou 310000,China)

机构地区：[1]海盐县人民医院药剂科,浙江嘉兴314300 [2]浙江大学医学院附属邵逸夫医院药学部,浙江杭州310000

出　　处：《实用药物与临床》2024年第6期435-438,共4页Practical Pharmacy and Clinical Remedies

摘　　要：目的为复方新诺明(Sulfamethoxazole/trimethoprim,SMZ-TMP)致高血钾不良反应(Adverse drug reaction,ADR)的药学管理提供参考。方法回顾性分析临床药师参与的1例重症肺孢子菌肺炎(Pneumocystis jiroveci pneumonia,PJP)患者使用SMZ-TMP后出现高钾血症的诊疗过程,对该ADR进行了相关性分析和SMZ-TMP致高血钾ADR风险因素和管理措施探讨。结果该患者在使用SMZ-TMP后血钾呈上升趋势,第6天达峰值5.78 mmol/L,经钙剂、胰岛素、降钾树脂以及连续肾脏替代治疗后,高钾血症得到有效缓解,Naranjo’s评分5分,二者很可能相关。高剂量SMZ-TMP以及合并使用损害肾钾排泄的药物使高钾血症风险增加。结论SMZ-TMP在使用过程中可能发生高血钾,合并使用泼尼松的患者,需提高警惕;在治疗过程中(前2~4 d)应及时监测血钾,确定易感患者,避免发生严重ADR;若患者不能耐受SMZ-TMP时,建议可选择伯氨喹+克林霉素或喷他脒或阿托伐醌替代治疗。Objective To provide experience and references for pharmaceutical monitoring of adverse drug reaction(ADR)of hyperkalemia in patients treated with sulfamethoxazole/trimethoprim(SMZ-TMP).Methods A retrospective analysis was conducted on the diagnosis and treatment process of one Pneumocystis jiroveci pneumonia(PJP)patient who suffered hyperkalemia after using SMZ-TMP,with the participation of a clinical pharmacist.The correlation analysis,risk factors of SMZ-TMP-induced hyperkalemia and the management measures were explored.Results The patient's blood potassium showed an upward trend after using SMZ-TMP,reaching a peak of 5.78 mmol/L on the 6th day.After treatment with calcium,insulin,potassium lowering resin,and blood purification,hyperkalemia was effectively relieved.Naranjo's score was 5,showing that the two might be related.Increased risk for hyperkalemia with SMZ-TMP was related to both higher dosages and use of other drugs that impaired renal potassium excretion.Conclusion SMZ-TMP may cause hyperkalemia,especially in patients treated with prednisone.Clinical pharmacists should promptly monitor blood potassium during the treatment process(the first 2~4 days)to identify susceptible patients in order to avoid severe ADR.If patients cannot tolerate SMZ-TMP,it is recommended to choose primaquine combined with clindamycin,pentamidine or atovaquone as alternative treatments.

关 键 词：复方新诺明 高血钾 不良反应 风险因素 

分 类 号：R969.3[医药卫生—药理学]