1例吲达帕胺致粒细胞缺乏症患者的药学监护

Pharmaceutical care of a patient with indapamide-induced agranulocytosis

目的通过吲达帕胺引起的粒细胞缺乏症患者病因分析与药学监护,探讨临床药师在粒细胞缺乏症患者治疗过程中的作用。方法临床药师参与1例粒细胞缺乏症患者的临床治疗,分析既往病史、现病史和用药史,采用我国药品不良反应关联性评价方法和Naranjo’s评估量表,从既往和正在使用的9种药物中筛选出吲达帕胺为可能导致本次粒细胞缺乏的药物,建议停用。同时优化降压治疗方案,建议换用氨氯地平,指导患者避免再次使用吲达帕胺,定期监测血常规。结果停用吲达帕胺后,患者中性粒细胞计数恢复正常。出院后监测血常规未发现异常。换用氨氯地平降压后,患者血压控制达标且未发生不良反应。结论临床药师通过参与1例吲达帕胺引起的粒细胞缺乏症患者的药学监护及时发现可疑药物,优化治疗方案,实施个体化用药监护,在临床治疗过程中发挥了重要作用。

Objective To explore the role of a clinical pharmacist in the treatment of a patient with agranulocytosis induced by indapamide via etiological analysis and pharmacological care.Methods One clinical pharmacist participated in the treatment of a patient with agranulocytosis.By analyzing medications used and using the Chinese Adverse Reaction Association Evaluation Method and the Naranjo's assessment scale,the pharmacist screened out indapamide as a possible drug that caused agranulocytosis from nine medications used.The pharmacist suggested withdrawing indapamide.The antihypertensive regimen was also optimized to switch to amlodipine and telmisartan.Results After withdrawal of indapamide,the patient's neutrophil count returned to normal.Blood routine was monitored after discharge and no abnormality was found.The antihypertensive regimen was also improved by recommending a switch to amlodipine,and the patient was given medication instructions to avoid reuse of indapamide and reminded of the need for regular blood monitoring.Conclusion The clinical pharmacist played an important role in the clinical treatment by offering pharmaceutical care of a patient with agranulocytosis caused by indapamide,finding suspicious drugs in time,optimizing the treatment plan,and implementing individualized pharmaceutical care.