他克莫司治疗皮肌炎性肺间质纤维化ADR药学监护1例  

A case report of pharmaceutical care on adverse drug reactions caused by tacrolimus in the treatment of dermatomyositis associated interstitial lung disease and literature review

作　　者：刘珠英[1] 祁军[2] 曲彩红[1] LIU Zhuying;QI Jun;QU Caihong(Office of Pharmacovigilance,the Third Affiliated Hospital,Sun Yat-sen University,Guangdong Guangzhou 510360,China;Department of Rheumatology and Immunolgy,the Third Affiliated Hospital,Sun Yat-sen University,Guangdong Guangzhou 510360,China)

机构地区：[1]中山大学附属第三医院药物警戒办公室,广东广州510360 [2]中山大学附属第三医院风湿免疫科,广东广州510360

出　　处：《中国医院药学杂志》2025年第6期724-728,共5页Chinese Journal of Hospital Pharmacy

摘　　要：他克莫司作为一种钙调磷酸酶免疫抑制剂,因其治疗窗窄,个体差异大,不良反应多,在治疗中需要给予更多的关注。该文通过报道1例55岁的女性患者因皮肌炎性肺间质纤维化(MDA5阳性)给予他克莫司+甲泼尼龙治疗,调整他克莫司剂量至1.5 mg bid,服药4 d后出现他克莫司中毒症状:血压升高(150~170/90~100 mmHg);乳酸升高至4 mmol·L^(-1);右肩剧烈疼痛,伴全身乏力;腹泻;他克莫司血药浓度高出检测限:>30.0 ng·mL^(-1)。临床药师建议:暂停他克莫司,使用苯巴比妥降低过高的他克莫司浓度;停用奥美拉唑,改为相互作用较小的泮托拉唑;予卡托普利降血压、碳酸氢钠降乳酸、曲马多止痛,症状逐渐缓解。另对国内外的相关文献资料进行回顾总结,给临床医生、药师及护士在他克莫司超说明书用药治疗中可能出现的问题提供警示和借鉴。Tacrolimus,as a calcineurin immunosuppressant,needs to be given more attention in treatment due to its narrow therapeutic window,obvious individual difference,and numerous adverse reactions.This paper reported a 55-year-old female patient with dermatomyositis associated interstitial lung disease(MDA5 positive)who was treated with tacrolimus and methylprednisolone.The dose of tacrolimus was adjusted to 1.5 mg bid,but after 4 days of medication,tacrolimus toxicity symptoms appeared,including increased blood pressure fluctuating between 150–170/90–100 mmHg,elevated lactate to 4 mmol·L^(–1),severe pain in right shoulder with general weakness and diarrhea.Blood concentration of tacrolimus was beyond the detection limit>30.0 ng·mL^(–1).Clinical pharmacist suggested that tacrolimus should be suspended and phenobarbital should be used to reduce the excessively high concentration of tacrolimus.Pantoprazole with less drug-drug interaction was used instead of omeprazole.Captopril for lowering blood pressure,sodium bicarbonate for lowering lactic acid,and tramadol for relieving pain,the symptoms of the patient gradually remitted.In addition,we reviewed relevant literature at home and abroad in order to provide warnings for clinicians,pharmacists and nurses on the off-label usage of tacrolimus.

关 键 词：他克莫司过量 皮肌炎性肺间质纤维化 药学监护 严重药品不良反应 超说明书用药 药物相互作用 

分 类 号：R969[医药卫生—药理学]