尹玉琴刘勇徐贵丽张云玲药物相互作用对环孢素a血药浓度的影响j.docVIP

肾移植术后抗感染治疗期间环孢素血药浓度监测与剂量调整1例 黄金柱1，罗晓2，李咏3，陈小红1，卢来春1* （1.第三军医大学第三附属医院药剂科，重庆 400042；2.首都医科大学附属友谊医院药剂科，北京 100032；3.武汉市普爱医院药剂科，武汉 430033；） 摘要 目的：分享肾移植术后患者抗感染治疗期间环孢素剂量调整的经验。方法：通过1例实际病例，并结合文献复习，总结肾移植术后使用阿奇霉素、伏立康唑抗感染治疗期间环孢素血药浓度监测与剂量调整的经验。结果：肾移植术后抗感染治疗时，大环内酯类药物如果无法代替，选用阿奇霉素可能是恰当的选择，必要时需要通过环孢素血药浓度监测来调整药物剂量；伏立康唑与环孢素的相互作用明确，两药联用时，必须通过环孢素血药浓度监测来调整其剂量。结论：肾移植术后，患者使用环孢素治疗期间，临床药师应该从与其有相互作用的药物中选择影响相对较小的药物；在药物剂量调整时，应该在抗感染药物和环孢素之间确定调整的目标药物，从而给临床医师提供合理建议。 关键词 肾移植术后；阿奇霉素；伏立康唑；环孢素；药物相互作用 One case of the cyclosporine blood concentration monitoring and dose adjustments after renal transplantation during Anti-infective therapy Huang Jinzhu1, Luo Xiao2,Li Yong3,Chen Xiaohong1 Lu laichun1* (1. Pharmacy Department, The Third Affiliated Hospital of Third Military Medical University, Chongqing 400042, China; 2. Pharmacy Department, Beijing Friendship Hospital,Capital Medical University, Beijing 100032, China; 3. Pharmacy Department, Wuhan PuAi Hospital, Wuhan 430033, China) ABSTRACT OBJECTIVE: To share the experience of cyclosporine dose adjustment during anti-infection treatment after the patient who accepted renal transplantation. METHODS: By one case actual cases and literature review summarizes the experience of cyclosporine blood concentration monitoring and dose adjustments in a renal transplantation patient who was using azithromycin and voriconazole.RESULTS: When anti-infective therapy in renal transplant recipients, if you can not replace macrolides, azithromycin choice might be appropriate choice, need to cyclosporine blood concentration monitoring to adjust the dose if necessary. Interaction between voriconazole and cyclosporine are clear, the dose must be adjusted by cyclosporine blood concentration monitoring if two drugs used simultaneously.CONCLUSION: After renal transplantation, clinical pharmacists should choose the best drug among interaction-drugs, when patients treated with cyclosporine.In dose adjustment, clinical pharmacists should balance the anti-infection drugs and