高血压患者门诊处方中代谢性药物相互作用的调查分析

发布时间：2018-10-10 10:20

【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P_(450)(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 the combined use of prescriptions for hypertension patients in our hospital and to provide reference for rational use of clinical drugs. Methods: the outpatient prescriptions of hypertension patients were collected from January 1 to February 1, 2015, and the prescriptions of two or more drugs were screened, and the contents of cytochrome P450) (CYP) substrates, inhibitors or inducers were recorded. Based on the theory of metabolic enzymes and related literatures and reports, the potential metabolic drug interactions in prescriptions were evaluated. Results: a total of 1 042 prescriptions were consulted and 551 prescriptions were screened out, including 249 prescriptions with metabolic drug interaction, accounting for 45.2%. The subtypes of CYP enzymes involved are mainly CYP3A4,CYP2C9,CYP2C19 and CYP2D6.. Of these, 214 prescriptions were related to CYP3A4, accounting for 199 of the drug interaction prescriptions, 27 with inhibitors, 11 with inducers, 27 with CYP2C9, and 27 with CYP3A4 substrates and substrates. There were 8 CYP2C9 substrates and 20 inhibitors for drug interaction prescriptions, 27 for CYP2D6 and 15 for CYP2D6 substrates and substrates. 12 were combined with inhibitors, 4 were related to CYP2C19, 2 were associated with CYP2C19 substrates and 2 were associated with inducers. Conclusion: metabolic drug interactions exist in outpatient prescriptions of hypertension patients in our hospital. In order to improve the rationality and safety of prescriptions, clinicians and pharmacists should try their best to avoid the combination of drugs with drug interactions reported in the literature, and select the same drugs with no or less interaction.
【作者单位】：河北省人民医院药学部;白求恩国际和平医院泌尿外科;
【基金】：河北省卫生计生委医学科学研究重点课题(No.20150132)
【分类号】：R972.4

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