依非韦伦与伏立康唑相互作用的药学监护  

Pharmaceutical care of drug interaction between voriconazole and efavirenz

作　　者：陈婷婷[1] 李由 张清泉[1] 林志强[1] Chen Tingting;Li You;Zhang Qingquan;Lin Zhiqiang(Department of Pharmacy,Quanzhou First Hospital,Fujian Province,Quanzhou 362000,China;Department of Infectious Disease,Quanzhou First Hospital,Fujian Province,Quanzhou 362000,China)

机构地区：[1]泉州市第一医院药剂科,泉州362000 [2]泉州市第一医院感染科,泉州362000

出　　处：《药物不良反应杂志》2024年第7期437-439,共3页Adverse Drug Reactions Journal

基　　金：泉州市科技局项目(2021C036R)。

摘　　要：1例27岁女性艾滋病患者使用替诺福韦、拉米夫定和依非韦伦(ART方案)治疗,因合并马尔尼菲篮状菌感染,联合应用伏立康唑200 mg静脉滴注、1次/12 h。用药第4天,伏立康唑血药谷浓度为0.1 mg/L。临床药师参与会诊,发现依非韦伦与伏立康唑存在药物相互作用,建议停用依非韦伦,换用多替拉韦。停用依非韦伦后,患者多次测定伏立康唑血药谷浓度并多次调整伏立康唑的剂量。依非韦伦停药14 d内,伏立康唑血药谷浓度变化缓慢(0.1~0.4 mg/L),14 d后谷浓度基本稳定。患者的伏立康唑剂量增至300 mg口服、1次/12 h后,伏立康唑谷浓度升至1.8 mg/L,达到参考值范围。本例提示对伏立康唑与依非韦伦联用的患者,在停用依非韦伦后,由于依非韦伦的代谢诱导作用仍然存在,仍需经验性增加伏立康唑的剂量,并依据治疗药物监测结果进行动态调整。A 27‑year‑old female patient with AIDS received tenofovir alafenamide lamivudine and efavirenz(ART scheme).Because of the combined infection of talaromyces marneffei,she was given intravenous infusion of voriconazole 200 mg once per 12 hours.On the 4th day of medication,the valley blood concentration of voriconazole was 0.1 mg/L.The clinical pharmacist participated in the consultation and found that there was a drug interaction between efavirenz and voriconazole.The pharmacist recommended to discontinue efavirenz and switch to dolutegravir.After discontinuing efavirenz,the patient measured the blood trough concentration of voriconazole multiple times and adjusted the dose of voriconazole multiple times.Within 14 days of efavirenz discontinuation,the blood trough concentration of voriconazole changed slowly(0.1-0.4 mg/L),and after 14 days,the blood trough concentration remained basically stable.After increasing the dose of voriconazole to 300 mg once every 12 hours orally,the blood trough concentration of voriconazole increased to 1.8 mg/L,which was within the reference value range.This case suggests that when voriconazole is used in combination with efavirenz,even after discontinuing efavirenz,the metabolic induction effect of efavirenz still exists.Therefore,it is necessary to empirically increase the dose of voriconazole and dynamically adjust it based on therapeutic drug monitoring results.

关 键 词：药物相互作用 伏立康唑 依非韦伦 治疗药物监测 剂量调整 马尔尼菲篮状菌 

分 类 号：R969.2[医药卫生—药理学]