摘要
目的探讨碳青霉烯类抗菌药物美罗培南与丙戊酸相互作用所致丙戊酸血药浓度异常的一般规律与作用机制，为临床医师提供药物治疗参考。方法报道美罗培南与丙戊酸相互作用致丙戊酸血药浓度严重异常1例，描述患儿的药物相互作用过程及治疗方案调整，同时检索1990～2015年间国外医药期刊公开报道的碳青霉烯类药物与丙戊酸相互作用的所有病例，对两者之间可能的影响因素进行分析和归纳。结果碳青霉烯类药物与丙戊酸之间的相互作用非常明显，该患儿发生药物相互作用24小时后丙戊酸血药浓度快速下降至有效治疗浓度（50～100mg／L）以下，且无法通过增加剂量来维持有效治疗浓度}患儿的丙戊酸血药浓度恢复缓慢，美罗培南停用2周以后才恢复到有效治疗浓度（为94．4mg／L）。通过回顾性研究分析，碳青霉烯类药物对丙戊酸血药浓度的影响可表现在对丙戊酸的吸收、分布、代谢、排泄等多个方面，其确切的作用机制尚待进一步研究证实。结论应高度警惕碳青霉烯类抗茵药物与丙戊酸之间的严重药物相互作用，临床应用时应避免两者合用。
Objective To discuss the general principles and mechanisms of abnormal serum concentration of VPA due to drug interaction between carbapenems and valproic acid and provide references of medication treatment for clini- cians. Methods A case with the abnormal in serum concentration of VPA due to drug interaction between meropenem and valproic acid was reported. Literatures of above drug interaction in overseas pharmaceutical journals from 1990 to 2015 were retrieved and analyzed. Results The pharmacokinetic interaction between valproate and meropenem led to a dramatic decrease of VPA concentrations without the range of 50-100mg/L within 24 hours in this patient. This abnormal interaction cannot be monitored by adjusting the doses. Recovery of plasma levels was difficult, it was restored to the ef- fective treatment concentration of 94.4 mg/L after meropenem disabled two weeks. Influence of carbapenems on VPA se- rum concentrations can be expressed in the absorption, distribution, metabolism, excretion and other aspects, its exact mechanism of drug interaction remains to be confirmed by further the severe drug interaction between carbaPenems and valproate. meropenem and valproate should not be administered together. studies. Conclusion More attention should be paid to To avoid patients＇ possible neurologic deterioration,
出处
《西部医学》
2015年第12期1874-1878,共5页
Medical Journal of West China
基金
南京市科技发展计划药学项目(2012YX009)
