基于药动学相互作用的2758张门诊地高辛处方联合用药分析

Analysis on Drug Application of 2 758 Outpatient Prescriptions of Digoxin Based on Pharmacokinetic Interactions

目的:了解门诊地高辛处方联合用药情况,为临床合理用药提供参考。方法:从药动学相互作用角度,对2018年7—12月中国科学技术大学附属第一医院(以下简称“我院”)2758张门诊地高辛处方联合用药情况进行回顾性统计分析。结果:2758张地高辛处方中存在药动学相互作用的联合用药2640例次,其中,分别与西药类P糖蛋白抑制剂及含P糖蛋白抑制剂成分的中成药、西药类P糖蛋白诱导剂及含P糖蛋白诱导剂成分的中成药联合应用2237、62例次,分别占总例次数的84.73%、2.35%;与西药类CYP3A4抑制剂及含CYP3A4抑制剂成分的中成药联合应用341例次,占总例次数12.92%;同一处方中含有多种CYP3A4抑制剂或P糖蛋白诱导剂或P糖蛋白抑制剂的处方共413张,占总处方数的14.97%。结论:我院门诊地高辛处方联合用药方面存在代谢性相互作用较多,临床医师与药师应加强监测,重点关注已有文献报道的能影响地高辛药动学的药物与地高辛的联合应用。

OBJECTIVE:To investigate the drug combination of digoxin in outpatient,so as to provide reference for its clinical rational application.METHODS:Based on pharmacokinetic interactions,2758 outpatient prescriptions of digoxin in the First Affiliated Hospital of USTC(hereinafter referred to as“our hospital”)from Jul.to Dec.2018 were retrospectively collected and analyzed in terms of drug combination.RESULTS:There were 2640 case-times of drug combination with pharmacokinetic interactions in the 2758 prescriptions,of which the combination with western medicine P-glycoprotein inhibitor and Chinese herbal ingredients in P-glycoprotein inhibitor,western medicine P-glycoprotein inducer and Chinese herbal ingredients in P-glycoprotein inducer were respectively 2237 and 62 case-times,accounted for 84.73%and 2.35%of the total cases;the combination with western medicine CYP3A4 inhibitor and Chinese herbal ingredients in CYP3A4 inhibitor were 341 case-times,accounted for 12.92%;there were 413 prescriptions containing multiple CYP3A4 inhibitors or P-glycoprotein inducer or P-glycoprotein inhibitor in the same prescription,accounted for 14.97%.CONCLUSIONS:There are many metabolic interactions in drug combination of digoxin prescription in our hospital,clinicians and pharmacists should strengthen monitoring,focus on the drug combination with digoxin that can affect the pharmacokinetics of digoxin reported in literature.