【摘要】 本文报道临床药师参与慢性阻塞性肺疾病合并曲霉菌感染使用伏立康唑导致骨痛的患者治疗过程。患者在治疗过程中突然出现骨痛,临床药师综合考虑建议检测患者CYP2C19基因型,监测伏立康唑血药浓度。检测结果提示患者为CYP2C19*2/*2（636GG,681AA）基因型,伏立康唑血药浓度为6.2 mg·L^-1。临床药师进一步建议将伏立康唑的给药剂量减半,并于治疗后第2天、第3天监测血药浓度。患者在剂量调整后的第2天骨痛明显好转,临床医生采纳药师建议后,持续使用伏立康唑联合其他抗菌药物2周后患者的症状明显好转,未再出现骨痛发作,好转出院。更多还原

【Abstract】 This paper reported the treatment of bone pain caused by voriconazole in one patient with chronic obstructive pulmonary disease complicated with aspergillus infection participated by clinical pharmacists. The patient suddenly appeared bone pain during the treatment,and clinical pharmacists considered and recommended monitoring the blood concentration of voriconazole and detecting the CYP2C19 genotype of the patient. The blood concentration of voriconazole was 6.2 mg·L^-1,and the result of gene test indicated that the patient was with the gene type of CYP2C19* 2/* 2 （636GG,681AA）. Clinical pharmacist further suggested that the dosage of voriconazole be adjusted to half,and then the blood concentration of voriconazole be continuously monitored half an hour before administration on the second and third day after treatment. The patient’s bone pain significantly alleviated on the second day after dose adjustment. After pharmacist’s recommendation,clinicians continued to use voriconazole in combination with other antibacterial drugs for 2 weeks,and the patient’s cough,sputum and wheezing significantly relieved. No bone pain attack occurred afterwards,and the patient was discharged.更多还原