摘要
目的:分析伏立康唑在肝功能不全患者中治疗药物监测结果,评估其与给药方案和安全性的关系,为临床个体化用药提供参考。方法:通过检索建库至2019年12月PubMed、Cochrane Library、万方、维普、中国期刊全文数据库,伏立康唑在肝功能不全患者中血药浓度及安全性信息,分析肝功能不全患者伏立康唑给药方案及血药浓度安全范围。结果:根据纳入标准共筛选出文献10篇,5篇为多样本回顾性研究,1篇为前瞻性研究,其余4篇为案例报道。Child-Pugh C级肝功能不全患者,采用维持剂量100 mg每12 h一次(q12h)安全性较高。伏立康唑不良反应的发生时间一般在7 d之内,目标谷浓度小于5 mg/L或5.3 mg/L时,不良反应发生率仍较高。主要不良反应包括神经毒性、幻觉、视觉障碍、胃肠道反应、皮疹等。结论:肝功能不全患者伏立康唑给药剂量应减量,并及时监测血药浓度,建议在保证疗效基础上,可进一步降低谷浓度以减少不良反应的发生。
AIM:To evaluate relationship between dosing schedules and safety of voriconazole by analyzing the monitoring results of voriconazole in patients with liver dysfunction,and to provide reference for the clinical individualized medication.METHODS:The blood concentration and safety information of voriconazole in patients with liver dysfunction was searched in PubMed,Cochrane Library,Wanfang,Weipu,and Chinese Journal Full-text Database from the establishment of the databases to December 2019,the dosing schedule and safety range of voriconazole for patients with liver dysfunction was analyzed.RESULTS:A total of 10 literatures were selected,5 of which were multi-sample retrospective studies and 1 of which was prospective study,and the remaining 4 were case reports.In Child-Pugh grade C liver dysfunction,a maintenance dose of 100 mg q12 h is more secure.The incidence of adverse reactions of voriconazole is generally within 7 days.When the target trough concentration is less than 5 mg/L or 5.3 mg/L,the incidence of adverse reactions is still high.The main adverse reactions include neurotoxicity,hallucinations,visual disturbances,gastrointestinal reactions and rash.CONCLUSION:The dose of voriconazole in patients with liver dysfunction should be reduced,and the drug concentration should be monitored in a timely manner.It is recommended that on the basis of ensuring the efficacy,trough concentration can be further reduced to reduce the occurrence of adverse reactions in patients with liver dysfunction.
作者
郭明星
郭恒
沈素
孙丽莹
崔向丽
GUO Mingxing;GUO Heng;SHEN Su;SUN Liying;CUI Xiangli(Pharmacy Department,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Liver Transplantation Center of General Surgery Department,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)
出处
《中国临床药理学与治疗学》
CAS
CSCD
2020年第7期757-763,共7页
Chinese Journal of Clinical Pharmacology and Therapeutics
基金
首都卫生发展科研专项(首发2020-1-2024)
国家卫健委卫生技术评估重点实验室2019年度开放基金(FHTA2019-02)。
关键词
伏立康唑
血药浓度
肝功能不全
voriconazole
plasma concentration monitoring
liver dysfunction
