某院含氯吡格雷门诊处方联合用药及其潜在药物相互作用分析

Analysis on Combination and Potential Drug Interactions of Out-patient Prescriptions Containing Clopidogrel in a Hospital

目的:分析医院门诊处方中氯吡格雷的使用情况,为临床安全、合理用药提供参考。方法:收集医院2020年9月—11月含氯吡格雷的门诊处方1867张,依据药动学和药效学原理,分析其氯吡格雷可能存在的潜在药物相互作用。结果:1867张处方中,氯吡格雷处方用药男-女之比为1.36∶1,职工医保为88.89%,均方药品数为(3.49±1.19)种,处方中"50 mg-q24h-po"用药方案占66.67%;氯吡格雷处方用药TOP 3科室为普通内科、心血管内科和神经内科,心脑血管病患者为主要用药对象;处方中含有的药品(如他汀类占56.40%、二氢吡啶类钙拮抗剂占19.82%、抗凝药占10.07%、抗血小板药占8.78%、质子泵抑制剂占3.80%、抗抑郁药占3.37%、胺碘酮占0.70%和中成药占14.30%)存在潜在相互作用。结论:医院氯吡格雷的用药老年患者中,处方用药普遍存在多药联用现象,部分患者处方用药还存在潜在的药物相互作用,临床应高度重视;药师应提高审方水平,重点关注潜在的药物不良相互作用。

Objective:To analyze the medication of clopidogrel in outpatient prescriptions in a hospital and to provide references for clinical safety and rational drug use.Methods:A total of 1867 out-patient prescriptions containing clopidogrel were collected in a hospital from September to November 2020.Potential drug interactions with clopidogrel were analyzed based on pharmacokinetic and pharmacodynamics principles.Results:Among the 1867 prescriptions,the male-female ratio of clopidogrel prescription was 1.36:1,employee health insurance accounted for 88.89%,the number of prescriptions was(3.49±1.19)kinds,and"50 mg-q24 h-po"drug regimen accounted for 66.67%.The TOP 3 departments of clopidogrel prescription were general medicine,cardiovascular medicine and neurology,and patients with cardiovascular and cerebrovascular diseases were the main drug targets.The drugs contained in the prescriptions(statins accounting for 56.40%,dihydropyridine calcium antagonists accounting for 19.82%,anticoagulants accounting for 10.07%,antiplatelet drugs accounting for 8.78%,proton pump inhibitors accounting for 3.80%,antidepressant drugs accounting for 3.37%,amiodarone accounting for 0.70%,Chinese patent medicine accounting for 14.30%)there are potential interactions.Conclusion:In the elderly patients using clopidogrel in a hospital,the phenomenon of multi-drug combination is common in prescription drugs,and potential drug interactions exist in some patients’prescription drugs,which should be paid great attention to clinically.Pharmacists should improve the level of prescription examination and focus on the potential adverse drug interactions.