住院患者中伏立康唑相关药物相互作用医嘱的发生情况分析

Occurrence of medical orders with drug‑drug interactions of voriconazole in hospitalized patients

目的了解伏立康唑治疗的住院患者中药物相互作用(DDI)医嘱的发生情况及常见药物。方法通过医院信息系统收集2018年5月至2023年8月福建省泉州市第一医院使用伏立康唑治疗并进行血药谷浓度(Cmin)检测的住院患者治疗信息,对伏立康唑治疗期间DDI医嘱的发生率、DDI所涉药物、DDI医嘱类型和风险级别、DDI发生的科室分布以及伏立康唑相关1/2类DDI医嘱(医嘱中含有不推荐与伏立康唑同时使用的药物/并用时需调整伏立康唑剂量的药物)患者伏立康唑的Cmin变化进行描述性统计分析。结果共纳入752例患者,其中592例(78.7%)存在伏立康唑相关DDI医嘱1344例次,涉及28种药物。67.7%(401/592)的患者并用了2种及以上DDI药物。伏立康唑相关DDI医嘱涉及最多的药物为糖皮质激素[91.6%(542/592)],其次为质子泵抑制剂[87.8%(520/592)]。28种伏立康唑相关DDI药物中属于1/2类DDI者有5种,包括利福平、奈玛特韦/利托那韦、苯巴比妥、苯妥英钠和利福布汀。5种药物涉及33例患者,其中51.5%(17例)患者的伏立康唑Cmin<1.0 mg/L;涉及患者最多的药物是利福平(17例)其次为奈玛特韦/利托那韦(10例)。伏立康唑与利福平、利福布汀、苯巴比妥和苯妥英钠并用时,多数,患者的伏立康唑Cmin显著下降。伏立康唑相关DDI医嘱在重症医学科发生率最高,其次为呼吸与危重症医学科。结论伏立康唑临床应用中DDI医嘱非常常见,且大多数患者并用了2种及以上DDI药物。糖皮质激素及质子泵抑制剂为最常见的并用药物。临床需要警惕伏立康唑与利福平、利福布汀、苯巴比妥及苯妥英钠的DDI发生。

Objective To understand the occurrence of drug?drug interaction(DDI)in medical orders and the relevant common medications of hospitalized patients treated with voriconazole.Methods The treatment information of hospitalized patients treated with voriconazole and had blood trough concentration(Cmin)results in Quanzhou First Hospital,Fujian Province from May 2018 to August 2023 was collected through the hospital information system.Descriptive statistical analysis was conducted on the incidence of DDI medical orders,the drugs involved in DDI,the types and risk levels of DDI,the departments where DDI occurred,and the Cmin changes of voriconazole in patients with 1 or 2 type of voriconazole?related DDI medical orders(including drugs not recommended in combination with voriconazole or voriconazole dose needs to be adjusted when combined)during voriconazole treatment.Results A total of 752 patients were included,of which 592(78.7%)had 1?344 medical orders with voriconazole?related DDI,involving 28 drugs.Among them,67.7%(401/592)of patients used 2 or more DDI drugs.Glucocorticoids[91.6%(542/592)],followed by proton pump inhibitors[87.8%(520/592)],were most frequently involved in the medical orders of DDI with voriconazole.Among the 28 voriconazole?related DDI drugs,5 were involved in type 1 or 2 DDI,including rifampicin,nirmatrelvir/ritonavir,phenobarbital,phenytoin sodium,and rifabutin.The 5 drugs involved 33 patients,of whom 51.5%(17 patients)had voriconazole Cmin<1.0?mg/L;rifampicin involved the most patients(17 patients),followed by nirmatrelvir/ritonavir(10 patients).When voriconazole was combined with rifampicin,rifabutin,phenobarbital and phenytoin sodium,its Cmin in most patients decreased significantly.The incidence of medical orders with voriconazole?related DDI was highest in the Intensive Care Unit,followed by the Department of Respiratory and Critical Care Medicine.Conclusions Medical orders with DDI are very common in the clinical application of voricona-zole,and most patients have used two or more DDI drugs,in which glucocorticoids and proton pump inhibitors appeared more common.It is necessary to be alert to the occurrence of DDI between voriconazole and rifampicin,rifabutin,phenobarbital and phenytoin sodium in clinic.