环孢素A联用伏立康唑致噬血细胞综合征患儿血药浓度显著升高1例分析

Analysis of High CsA Blood Concentration Induced by the Combination of Cyclosporin A and Voriconazole in A Child with Hemophagocytic Lymphohistiocytosis

临床药师通过血药浓度监测,发现1例噬血细胞综合征患儿环孢素A(CsA)血药浓度升高异常,查阅患儿住院期间用药信息,并结合文献复习,从生理因素、食物因素、药物相互作用和基因多态性等方面分析发生血药浓度异常升高的原因。发现导致本例患儿CsA血药浓度显著升高的最主要原因为CsA联用伏立康唑的药物相互作用,调整患儿CsA用药剂量后CsA血药浓度恢复平稳。临床上联合使用CsA和伏立康唑治疗时,应注意监测CsA血药浓度,及时调整CsA剂量,降低药品不良反应发生率。

Therapeutic drug monitoring（ TDM） of cyclosporinA（ CsA） was performed in a child with hemophagocytic lymphohistiocytosis（ HLH）,and abnormal high blood concentration of CsA was noticed. The medication information of the child during hospitalization as well as the related medical literature was collected. Then the cause of the abnormal high blood CsA was analyzed from four aspects including physiological factors,food factors,drug-drug interactions and gene polymorphism. The analysis suggested that the main reason of the abnormal high CsA blood concentration was due to the drug interaction between CsA and voriconazole used in combination.After dosage adjustment,the CsA blood concentration returned normal. The study indicated that when combinated use of CsA and voriconazole is performed,more attention should be paid to CsA blood concentration and the dose of CsA should be timely adjusted,so as to reduce the incidence of adverse drug reactions.