某院2016～2018年CYP3A4酶中效抑制剂地尔硫?联合用药情况调查

Investigation of the combination of moderate cytochrome P450 3A4 inhibitor diltiazem in Metabolic Disease Hospital of Tianjin Medical University in 2016-2018

目的调查某院CYP3A4酶中效抑制剂与地尔硫[艹卓]的联合用药情况,为临床合理用药提供参考.方法对某院门诊药房2016~2018年地尔硫[艹卓]的联用处方进行汇总分析,包括患者的基本情况,联用CYP3A4酶诱导剂或者底物药物的种类、联用处方数和联用剂量.参考现有文献,从CYP3A4酶代谢角度对联合用药的合理性进行分析.结果收集地尔硫[艹卓]联用处方397例,联用具有药物间相互作用的处方309例,占77.8%.联用药物包括CYP3A4酶诱导剂吡格列酮,CYP3A4酶底物阿托伐他汀、辛伐他汀、硝苯地平、氨氯地平、非洛地平、沙格列汀和瑞格列奈.结论应该避免已经明确的具有相互作用的药物联用,如果联用,应该调整剂量、加强患者用药教育,并监测可能导致的药物不良反应.

Objective To investigate the combined use of diltiazem, a moderate inhibitor of CYP3A4 enzyme in our hospital, so as to provide a reference for clinical rational drug use. Methods From 2016 to 2018, the combined prescriptions of designer in outpatient pharmacy of our hospital were analyzed, including the basic information of patients, the type of CYP3A4 enzyme inducer or substrates, the number of combined prescriptions and the combined dose. By referring to the existing literature, the rationality of combined drugs was analyzed from the perspective of CYP3A4 enzyme metabolism. Results Diltiazem combined prescriptions were collected in 397 cases, and drug-drug interactions were observed in 309 cases, accounting for 77.8%.Combined drugs include pioglitazone, the CYP3A4 enzyme inducer, and the substrates of CYP3A4, including atorvastatin, simvastatin, nifedipine, amlodipine, fellodipine, sagliptin and reaglinide. Conclusion Clearly defined drug combinations with interactions should be avoided, and, if so, dosage should be adjusted, patient medication education strengthened, and potential adverse drug reactions monitored.