2例重度肝硬化患者伏立康唑血药浓度监测与不良反应分析
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摘要
病例1:1例63岁男性患者,因乙型肝炎肝硬化失代偿期、原发性肝细胞癌应用伏立康唑预防真菌感染,初始剂量为400 mg,q 12 h,po,维持剂量为100 mg,q 12 h,po,患者在用药第5天出现视物模糊、一过性黄视等症状,监测血药浓度为16.56μg·m L~(-1),停药第9天症状消失。病例2:1例60岁女性患者,基础疾病为乙型肝炎肝硬化失代偿期,入院2周后痰培养提示黄曲霉菌,给予伏立康唑抗真菌治疗,初始剂量为6 mg·kg~(-1),q 12 h,ivgtt,维持剂量为2 mg·kg~(-1),q 12 h,ivgtt,用药7 d后减量至1.2 mg·kg~(-1),q 12 h,ivgtt,用药第11天出现视物朦胧、复视等症状,监测血药浓度为11.36μg·mL~(-1),停药7 d后不良反应消失。
Case 1: A 63-years-old man, who had decompensated hepatitis B cirrhosis and primary hepatocellular carcinoma, was treated with voriconazole to prevent fungal infection. The initial dose was 400 mg, q 12 h, po, and the maintenance dose was 100 mg, q 12 h, po. On the fifth day of medication, symptoms such as blurred vision and transient yellow vision were occurred. The blood drug concentration was detected at 16.56 μg·mL~(-1), and the symptoms disappeared on the ninth day after voriconazole withdrawl. Case 2: A 60-years-old woman, who had decompensated hepatitis B cirrhosis, was found to be infected with Aspergillus flavus in sputum culture at the second week after hospital treatment, and was then treated with voriconazole for antifungal therapy. The initial dose was 6 mg·kg~(-1), q 12 h, ivgtt, and the maintenance dose was 2 mg·kg~(-1), q 12 h, ivgtt. On the 7 th day of treatment, the dosage was reduced to 1.2 mg·kg~(-1), q 12 h, ivgtt. Symptoms such as haze and diplopia appeared on the 11 th day of treatment. The blood concentration was 11.36 μg·mL~(-1), and the adverse effects disappeared after seven days of voriconazole withdrawal.
Case 1: A 63-years-old man, who had decompensated hepatitis B cirrhosis and primary hepatocellular carcinoma, was treated with voriconazole to prevent fungal infection. The initial dose was 400 mg, q 12 h, po, and the maintenance dose was 100 mg, q 12 h, po. On the fifth day of medication, symptoms such as blurred vision and transient yellow vision were occurred. The blood drug concentration was detected at 16.56 μg·mL~(-1), and the symptoms disappeared on the ninth day after voriconazole withdrawl. Case 2: A 60-years-old woman, who had decompensated hepatitis B cirrhosis, was found to be infected with Aspergillus flavus in sputum culture at the second week after hospital treatment, and was then treated with voriconazole for antifungal therapy. The initial dose was 6 mg·kg~(-1), q 12 h, ivgtt, and the maintenance dose was 2 mg·kg~(-1), q 12 h, ivgtt. On the 7 th day of treatment, the dosage was reduced to 1.2 mg·kg~(-1), q 12 h, ivgtt. Symptoms such as haze and diplopia appeared on the 11 th day of treatment. The blood concentration was 11.36 μg·mL~(-1), and the adverse effects disappeared after seven days of voriconazole withdrawal.
引文
[1]刘云.侵袭性肺曲霉菌感染患者使用伏立康唑致视觉模糊1例分析[J].中国当代医药,2018,25(18):158-160.
[2]王冬,曹江,江学维,等.伏立康唑致视觉障碍的文献计量学研究[J].药物不良反应杂志,2013,15(6):325-329.
[3]冯飞飞,张晓云,任秋霞,等.伏立康唑致精神、视觉障碍和肝功能异常1例[J].中国药物应用与监测,2017,14(2):128-129.
[4]Pascual A, Calandra T, Bolay S, et al. Voriconazole therapeutic drug monitoring in patients with invasive mycoses improves efficacy and safety outcomes[J]. Clin Infect Dis, 2008, 46(2):201-211.
[5]Ashbee HR, Barnes RA, Johnson EM, et al. Therapeutic drug monitoring(TDM)of antifungal agents:guidelines from the British Society for Medical Mycology[J]. J Antimicrob Chemother, 2014, 69(5):1162-1176.
[6]王晓梅,张林.84例伏立康唑不良反应分析[J].医药导报,2017,36(12):1432-1436.
[7]彭文绣,任秋霞,李璇,等.血药浓度监测在肝衰竭患者应用伏立康唑治疗肺部感染中的作用[J].中国药房,2016,27(2):267-268.
[8]Weiler S, Zoller H, Graziadei I, et al. Altered pharmacokinetics of voriconazole in a patient with liver cirrhosis[J]. Antimicrob Agents Chemother, 2007, 51(9):3459-3460.
[9]Purkins L, Wood N, Ghahramani P, et al. Pharmacokinetics and safety of voriconazole following intravenous-to oral-dose escalation regimens[J]. Antimicrob Agents Chemother, 2002,46(8):2546-2553.
[10]Yamada T, Imai S, Koshizuka Y, et al. Necessity for a significant maintenance dosage reduction of voriconazole in patients with severe liver cirrhosis(Child-Pugh class C)[J]. Biol Pharm Bull,2018, 41(7):1112-1118.
[2]王冬,曹江,江学维,等.伏立康唑致视觉障碍的文献计量学研究[J].药物不良反应杂志,2013,15(6):325-329.
[3]冯飞飞,张晓云,任秋霞,等.伏立康唑致精神、视觉障碍和肝功能异常1例[J].中国药物应用与监测,2017,14(2):128-129.
[4]Pascual A, Calandra T, Bolay S, et al. Voriconazole therapeutic drug monitoring in patients with invasive mycoses improves efficacy and safety outcomes[J]. Clin Infect Dis, 2008, 46(2):201-211.
[5]Ashbee HR, Barnes RA, Johnson EM, et al. Therapeutic drug monitoring(TDM)of antifungal agents:guidelines from the British Society for Medical Mycology[J]. J Antimicrob Chemother, 2014, 69(5):1162-1176.
[6]王晓梅,张林.84例伏立康唑不良反应分析[J].医药导报,2017,36(12):1432-1436.
[7]彭文绣,任秋霞,李璇,等.血药浓度监测在肝衰竭患者应用伏立康唑治疗肺部感染中的作用[J].中国药房,2016,27(2):267-268.
[8]Weiler S, Zoller H, Graziadei I, et al. Altered pharmacokinetics of voriconazole in a patient with liver cirrhosis[J]. Antimicrob Agents Chemother, 2007, 51(9):3459-3460.
[9]Purkins L, Wood N, Ghahramani P, et al. Pharmacokinetics and safety of voriconazole following intravenous-to oral-dose escalation regimens[J]. Antimicrob Agents Chemother, 2002,46(8):2546-2553.
[10]Yamada T, Imai S, Koshizuka Y, et al. Necessity for a significant maintenance dosage reduction of voriconazole in patients with severe liver cirrhosis(Child-Pugh class C)[J]. Biol Pharm Bull,2018, 41(7):1112-1118.