| 碳青霉烯类抗生素致丙戊酸血药浓度降低 |
| 投稿时间：2017-08-25 修订日期：2018-01-04 点此下载全文 |
| 引用本文：齐阳,周宇,宋洪涛.碳青霉烯类抗生素致丙戊酸血药浓度降低[J].药学实践杂志,2018,36(4):369~372 |
| 摘要点击次数: 1380 |
| 全文下载次数: 1127 |
|
|
| 中文摘要:目的 探讨影响丙戊酸体内代谢的危险因素，促进合理用药水平，降低癫痫复发率。方法 分析2例给予丙戊酸后，血药浓度监测结果均小于1 μg/ml的患者。临床药师查阅文献，从药物相互作用、肝药酶活性及基因多态性等多方面积极分析并查找相关原因。结果 2例患者联合使用碳青霉烯类抗生素与丙戊酸，且同时服用肝药酶诱导剂苯巴比妥或利福霉素钠，促进丙戊酸代谢。基因型检测发现2例患者均携带CYP2C19突变型等位基因，丙戊酸代谢能力为中等或慢代谢。提示药物相互作用和CYP450催化活性增强是丙戊酸血药浓度降低的主要原因。结论 在碳青霉烯类抗生素和丙戊酸合用时，临床医生应密切关注丙戊酸血药浓度和癫痫发作症状。 |
| 中文关键词:丙戊酸 碳青霉烯类抗生素 血药浓度监测 药物相互作用 基因多态性 |
| |
| Abnormal reduction of valproic acid plasma concentration caused by carbapenem antibiotics |
|
|
| Abstract:Objective To discuss the risk factors affecting the metabolism of valproic acid (VPA),improve the rational medication and reduce the rate of epilepsy recurrence. Methods Two hospitalized patients were analyzed after being administrated VPA for epilepsy prevention or treatment,with serum VPA levels less than 1 μg/ml. The relevant reasons in literature review in many aspects were collected by clinical pharmacists,such as drugs interaction,hepatic drug-metabolizing cytochrome P450 (CYP) enzymes activity and genetic polymorphism. Results The reduced serum VPA levels were primarily caused by combination of valproic acid and carbapenem. The co-administration of Phenobarbital and rifamycin sodium,as CYP inducers,promoted the metabolism of valproic acid. In addition,the two patients carried mutant allele of CYP2C19,with middle or low grade of VPA metabolism ability. These indicated the dominant role of the medication interaction and the enhanced CYP450 activity in leading to the reduced VPA serum levels. Conclusion Clinicians should closely monitor the serum VPA concentration and the recurrence of seizures when carbapenem and VPA combined. |
| keywords:valproic acid carbapenem antibiotics blood drug concentration detection drug interaction genetic polymorphism |
| 查看全文 查看/发表评论 下载PDF阅读器 |
|
| 关闭 |
