重症患者新型冠状病毒感染应用奈玛特韦/利托那韦的药学监护实践

Pharmacological monitoring practice of Nirmatrelvir/Ritonavir in critically ill patients with COVID-19

目的总结临床药师对治疗新型冠状病毒感染(COVID-19)的口服新药——奈玛特韦片/利托那韦片组合包装(Paxlovid)的药学监护要点。方法收集2022年12月~2023年1月奥密克戎毒株暴发期间,山东大学附属威海市立医院住院重症患者应用Paxlovid的病例10例,临床药师从适应证、启用时机、用法用量、不良反应、药物间相互作用等方面评价药物应用的合理性,并参与临床实施药学监护。结果10例患者中,男性4例,女性6例,平均年龄(73.8±12.3)岁。临床药师会诊确定这10例患者的COVID-19的分型为中型,符合Paxlovid的适应证,除1例患者启用时间较晚,其余患者均在核酸阳性5 d内应用Paxlovid,服药后核酸转阴时间平均为(7.9±4.7)d。临床药师通过计算患者的肾小球滤过率来调整剂量,并查阅文献资料对其中3例无法口服的重症患者采取鼻饲给药方式。通过不良反应评估量表,判断2例患者出现的消化道不良反应与Paxlovid的使用很可能相关。对患者进行药物重整,发现3例患者应用的药物与Paxlovid有潜在相互作用风险,临床药师与主治医师进行沟通,对有相互作用风险的药物进行停药、更换品种或严密监测指标等处理。结论Paxlovid作为口服治疗COVID-19的新药,在临床中表现出较好的优势,但因适用人群、药物相互作用等问题,存在应用上的局限性。临床药师通过总结Paxlovid应用时的注意事项,可在查房时运用思维导图一对一地对患者进行个体化药学监护,以保障药物治疗的安全性和合理性。

Objective To summarize the key points of pharmacological monitoring of Nirmatrelvir Tablets/Ritonavir Tablets(co-packaged)(Paxlovid),a new oral drug for the treatment of Corona virus disease 2019(COVID-19),by clinical pharmacists.Methods 10 cases of Paxlovid application in critically ill patients hospitalized in Weihai Municipal Hospital,Cheeloo College of Medicine,Shandong University during the outbreak of Omicron strain from December 2022 to January 2023 were collected,and clinical pharmacists evaluate the rationality of drug application in terms of indications,start time,dosage,adverse effects and drug-drug interactions,and participate in clinical implementation of pharmacological monitoring.Results Among the 10 patients,4 were male and 6 were female,with an average age of(73.8±12.3)years.Clinical pharmacist consultation determined that the phenotype of COVID-19 in these 10 patients was medium-sized,which was consistent with the indication of Paxlovid.Except for 1 patient who was activated late,the rest of the patients applied Paxlovid within 5 d of nucleic acid positivity,and the average time of nucleic acid conversion after drug administration was(7.9±4.7)d.The clinical pharmacist adjusted the dosage by calculating the glomerular filtration rate of the patients,and reviewed the literature to adopt nasal administration for 3 of the critically ill patients who were unable to take the drug orally.The Adverse Reaction Assessment Scale determined that the GI adverse reactions experienced by 2 patients were likely related to the use of Paxlovid.Drug reorganization was performed on the patients,and it was found that there was a potential risk of interaction between the drugs applied to the 3 patients and Paxlovid,and the clinical pharmacist communicated with the attending physician,and the drugs with the risk of interaction were treated by discontinuing the drugs,changing the varieties,or monitoring the indexes closely.Conclusion Paxlovid,as a new drug for oral treatment of COVID-19,has shown better advantages in the clinic,but there are limitations in its application due to issues such as the applicable population and drug interactions.By summarizing the precautions in the application of Paxlovid,clinical pharmacists can use mind mapping to individualize pharmacological supervision of patients one-on-one during room visits to ensure the safety and rationality of drug therapy.