伏立康唑致1例肾移植患者他克莫司血药浓度升高

Pharmaceutical Care on Voriconazole Raised Tacrolimus Blood Concentration in a Renal Transplant Patient

临床药师在查房中发现肾移植患者他克莫司血药浓度过高,分析原因为治疗其真菌感染的伏立康唑抑制了他克莫司的代谢酶细胞色素CYP3A的活性所致。药师由此提出减少他克莫司用量(当他克莫司与伏立康唑联合用药时,他克莫司的剂量调整为原来的1/3)及监测其血药浓度,建议被采纳,患者的他克莫司血药浓度重新达到目标范围。

Voriconazole induced blood drug concentration raise of tacrolimus in a renal transplant patient was found by clinical pharmacists. The reason, the mechanism and the interaction of drugs were analyzed by clinical pharmacists, and finally rational proposals were given for the patient. Clinical pharmacists' medication intervention successfully helped the patient reached target steady-state blood drug concentration.Thus, clinical pharmacists should give the medication instructions to patients who receive tacrolimus after renal transplantation and monitor closely the blood drug concentration of tacrolimus during the process of treatment.