伏立康唑的治疗药物监测:国内外相关指南概览

Therapeutic drug monitoring of voriconazole:an overview of relevant guidelines at home and abroad

2013年3月至2018年12月,日本、英国、加拿大、澳大利亚和中国相继发布了有关伏立康唑的治疗药物监测指南。国内外指南一致推荐使用伏立康唑时应给予负荷剂量,并在第3天监测患者血药谷浓度;调整给药剂量、发生不良事件或疗效欠佳、增加或停用可能发生相互作用的药物以及序贯给药时,应再次进行血药浓度监测。伏立康唑相关不良事件的临床类型已较为明确,治疗期间发生不良事件后可根据其严重程度分级给予停药或减量等处理。伏立康唑不但是细胞色素P450(CYP)2C9、CYP2C19和CYP3A4的底物,也是其抑制剂,应注意与其他药物联用时的相互作用。今后需要进一步开展研究,积累不同用药目的、不同疾病或不同真菌感染、Child⁃Pugh C级严重肝病和<2岁儿童等人群应用该药的循证医学证据,为临床个体化治疗提供参考。

From March 2013 to December 2018,Japan,the United Kingdom,Canada,Australia,and China successively issued guidelines on therapeutic drug monitoring of voriconazole.It is recommended in guidelines at home and abroad that voriconazole should be given a loading dose,and the blood drug concentration of patients should be monitored on the third day;when adjusting the dose,adverse events occurrence or poor efficacy,increasing or stopping the drugs that may interact,and sequential administration,the blood drug concentration should be monitored again.The clinical characteristics of voriconazole⁃related adverse events have been clearly defined.After adverse reactions occur during the treatment period,the drug can be stopped or reduced according to its severity.Voriconazole is not only the substrate of cytochrome P450(CYP)2C9,CYP2C19 and CYP3A4,but also an inhibitor of them.We should pay attention to the interaction between voriconazole and other drugs.In the future,further research is needed to accumulate more evidence⁃based medical evidences for the use of the drug in different medication purposes,different diseases or different fungal infections,Child⁃Pugh grade C severe liver disease,and children<2 years old,so as to provide reference for clinical individualized treatment.