精神科住院患者医嘱中CYP450介导的药物相互作用风险分析

Risk Analysis of CYP450-mediated Drug Interaction in Medical Orders of Psychiatric Inpatients

关键词:  细胞色素P450酶  CYP450  精神科  药物相互作用  代谢

Key words:  cytochrome P450s  CYP450  psychiatry  drug interaction  metabolism

摘要:

目的 调查河北医科大学第一医院精神科住院患者存在细胞色素P450酶（CYP450）介导的药物相互作用的住院医嘱，分析潜在具有临床意义的药物相互作用，为临床用药提供参考。方法 对河北医科大学第一医院2018年7月1日-12月31日精神科住院患者所有运行病历的用药情况进行统计分析，筛选联用≥ 2种药物的医嘱，记录联合用药中含有CYP450酶底物、抑制剂或诱导剂的情况。以代谢酶学理论为指导，以药品说明书、相关文献报道为基础，评价医嘱中潜在的代谢性药物相互作用，并统计临床发生实际药物相互作用的病例。结果 共查阅1 658份病历，其中存在代谢性药物相互作用的病历227份，占13.7%，涉及的CYP酶的亚型主要有CYP2D6（n=176，77.5%）、CYP3A4（n=105，46.3%）、CYP2C19（n=24，10.6%）和CYP2C9（n=5，2.2%）。临床发生实际药物相互作用的病历6份，占2.6%。结论 河北医科大学第一医院精神科住院患者病历中存在潜在的代谢性药物相互作用较多。为提高用药的疗效与安全，临床上应尽量避免联用已有文献报道的存在不良相互作用的药物，选择没有相互作用或相互作用较少的同类药物。

Abstract:

OBJECTIVE To investigate the existence of cytochrome P450(CYP450)-mediated drug interactions in medical orders of psychiatric inpatients in the First Hospital of Hebei Medical University, analyze the potential drug interactions of clinical significance, and provide reference for clinical use of drugs. METHODS Statistical analysis of all operating medical orders of psychiatric inpatients from July 1 to December 31, 2018 in the First Hospital of Hebei Medical University was carried out, and ≥ 2 medical orders were used in combination to record the CYP450 enzyme substrates, inhibitors, or inducers were contained in the combined drug use. Based on the theory of metabolic enzymes and related drug instructions and literature, the potential metabolic drug interactions in medical orders were evaluated, and counted the cases of actual clinical drug interactions. RESULTS A total of 1 658 cases were examined, of which 227 were metabolic drug interactions, accounting for 13.7%. The subtypes involved in the CYP enzyme were mainly CYP2D6(n=176, 77.5%), CYP3A4(n=105, 46.3%), CYP2C19(n=24, 10.6%), and CYP2C9(n=5, 2.2%). Six cases of clinical drug interactions were occurred, accounting for 2.6%. CONCLUSION There are many potential metabolic drug interactions in the medical orders of psychiatric inpatients in the First Hospital of Hebei Medical University. In order to improve the efficacy and safety of treatment, it is necessary to avoid the combination of drugs with adverse interaction reported in the literature, and to select similar drugs that have no interaction or less interaction.