造血干细胞移植患者中伏立康唑与环孢素及他克莫司的相互作用

Interaction of Voriconazole with Cyclosporin A or Tacrolimus in Recipients of Hematopoietic Stem Cell Transplantation

关键词:  伏立康唑  环孢素A  他克莫司  血药浓度  药物相互作用

Key words:  voriconazole  cyclosporin A  tacrolimus  drug concentration  drug interactions

摘要:

目的 通过监测造血干细胞移植患者伏立康唑和免疫抑制剂（环孢素A、他克莫司）的稳态血药谷浓度，探讨伏立康唑与环孢素及他克莫司之间的作用。方法 回顾性分析2016年6月-12月于宁波市第一医院血液科住院治疗的造血干细胞移植患者的伏立康唑、环孢素A以及他克莫司的稳态血药浓度数据。结果 伏立康唑与环孢素A合用后，环孢素A稳态谷浓度升高41.55%（P<0.05），伏立康唑稳态谷浓度下降23.31%；伏立康唑与他克莫司合用后，他克莫司稳态谷浓度升高17.52%，伏立康唑稳态谷浓度下降29.45%（P<0.05）。结论 伏立康唑联用环孢素A或他克莫司时，建议诊疗过程严密监测免疫抑制剂及伏立康唑的血药浓度，以便及时调整治疗药物剂量，保障安全、有效、合理用药。

Abstract:

OBJECTIVE To investigate the interaction between voriconazole with cyclosporin A or tacrolimus, the steady-state concentration of voriconazole and immunosuppressive agents (cyclosporin A and tacrolimus) were detected in recipients of hematopoietic stem cell transplantation. METHODS The steady-state concentration data of voriconazole, cyclosporine A and tacrolimus in recipients of hematopoietic stem cell transplantation were retrospectively analyzed from 2016 June to December in hematology ward of Ningbo First Hospital. RESULTS When voriconazole combined with cyclosporin A, the steady-state concentration of cyclosporine A was increased by 41.55% (P<0.05), and the steady-state concentration of voriconazole decreased by 23.31%; When voriconazole combined with tacrolimus, the steady-state concentration of tacrolimus was increased by 17.52%, and the steady-state concentration of voriconazole decreased by 29.45% (P<0.05). CONCLUSION In the cases of combination drug therapy, it is recommended that the concentration of immunosuppressive agents and voriconazole shall be monitored closely. Only in this way, the medication can be used safely, effectively and reasonably.