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

One case of cyclosporine blood concentration monitoring and dose adjustments after renal transplantation during anti-infective therapy

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。

Objective： To share the experience of cyclosporine dose adjustment during anti-infection treatment after receiving renal transplantation. Methods： Via providing one actual case and literature review, the experience of cyclosporine blood concentration monitoring and dose adjustments was summerized especially for renal transplantation patients receiving anti-infective therapy of azithromycin and voriconazole. Results： During anti-infective therapy in renal transplant recipients, if macrolides can＇t be replaced,azithromycin might be the appropriate choice, and if necessary, adjust the dose based on cyclosporine blood concentration monitoring. Interactions between voriconazole and cyclosporine are clear, and the dose must be adjusted based on cyclosporine blood concentration monitoring if two drugs are administered simultaneously. Conclusion： After renal transplantation, clinical pharmacists should choose the drug with relatively less possibility of interacting with other drugs for patients being treated with cyclosporine. As for dose adjustment, clinical pharmacists should balance the anti-infection drugs and cyclosporine, and decide the drug to be adjusted in order to provide proper advices to clinicians.