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高血压患者门诊处方中代谢性药物相互作用的调查分析
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| 篇名： | 高血压患者门诊处方中代谢性药物相互作用的调查分析 |
| TITLE： | |
| 摘要： | 目的：了解我院高血压患者门诊处方的联合用药情况，为临床药物的合理使用提供参考。方法：收集该院2015年1月1日－2月1日诊断为高血压患者的门诊处方，筛选联用2种及2种以上药物的处方，记录联合用药中含有细胞色素P450（CYP）酶底物、抑制剂或诱导剂的情况。以代谢酶学理论为指导，以相关文献及资料报道为基础，评价处方中潜在的代谢性药物相互作用。结果：共查阅1 042张处方，筛选出联合用药处方551张，其中存在代谢性药物相互作用的处方249张，占45.2％。涉及的CYP酶的亚型主要有CYP3A4、CYP2C9、CYP2C19和CYP2D6。其中，与CYP3A4相关的处方共214张，占存在药物相互作用处方的85.9％，CYP3A4底物与底物联用的有199张、与抑制剂联用的有27张、与诱导剂联用的有11张；与CYP2C9相关的处方共27张，占存在药物相互作用处方的10.8％，CYP2C9底物与底物联用的有8张、与抑制剂联用的有20张；与CYP2D6相关的处方共27张，占存在药物相互作用处方的10.8％， CYP2D6底物与底物联用的有15张、与抑制剂联用的有12张；与CYP2C19相关的处方共4张，占存在药物相互作用处方的1.6％，CYP2C19底物与抑制剂联用的有2张、与诱导剂联用的有2张。结论：我院高血压患者门诊处方中存在的代谢性药物相互作用较多。为了提高处方的合理性与安全性，临床医师和药师应尽量避免与已有文献报道的存在药物相互作用的药物联用，选择没有相互作用或相互作用较少的同类药物。 |
| ABSTRACT： | OBJECTIVE： To investigate drug combination in outpatient prescriptions of hypertension patients in our hospital， provide reference for rational drug use in clinic. METHODS： The outpatient prescriptions of patients diagnosed as hypertension during Jan. 1st to Feb. 1st in 2015 were collected from the hospital. The prescriptions of two or more than two drugs were screened， and the prescriptions of drug combination containing CYP enzyme substrate， inhibitor or inducer were recorded. Guided by metabolic enzymology theory， the potential metabolic drug interactions in prescriptions were evaluated on the basis of relevant literature and data reports. RESULTS： Totally 1 042 prescriptions were consulted. The prescriptions of the combined medication were 551， and the potential metabolic drug-drug interactions were detected at 249 prescriptions， accounting for 45.2％. Main CYP enzyme subtypes were CYP3A4， CYP2C9， CYP2C19 and CYP2D6. Totally 214 prescriptions were correlated with CYP3A4， accounting for 85.9％ of drug interaction prescriptions； CYP3A4 substrate combined with substrate in 199 prescriptions， with inhibitor in 27 prescriptions， and with inducer in 11 prescriptions. Totally 27 prescriptions were correlated with CYP2C9， accounting for 10.8％ of drug interaction prescriptions； CYP2C9 substrate combined with substrate in 8 prescriptions， and with inhibitor in 20 prescriptions. Totally 27 prescriptions were correlated with CYP2D6， accounting for 10.8％ of drug interaction prescriptions； CYP2D6 substrate combined with substrate in 15 prescriptions， and with inhibitor in 12 prescriptions. Totally 4 prescriptions were correlated with CYP2C19， accounting for 1.6％ of drug interaction prescriptions； CYP2C9 substrate combined with inhibitor in 2 prescriptions， and with inducer in 2 prescriptions. CONCLUSIONS： Many metabolic drug-drug interactions are detected in the outpatient prescriptions of hypertension patients in our hospital. In order to improve the rationality and safety of the prescription， clinicians and pharmacists should pay attention to the drug combinations with drug-drug interactions which have been reported in the existing literature， and choose similar drugs without or with little interactions. |
| 期刊： | 2017年第28卷第35期 |
| 作者： | 宋浩静， 杜亚斌，白万军，邱志宏，赫立恩，董占军 |
| AUTHORS： | SONG Haojing，DU Yabin，BAI Wanjun，QIU Zhihong，HE Li’en，DONG Zhanjun |
| 关键字： | 代谢；药物相互作用；CYP酶；处方分析 |
| KEYWORDS： | Metabolism； Drug interaction； CYP enzyme； Prescription analysis |
| 阅读数： | 360 次 |
| 本月下载数： | 7 次 |
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