持续输液中万科米辛的剂量和暴露:一项回顾性研究
Judith Y M N Derijks-Engwegen1, Nynke G L Jager1
1Department of Pharmacy, Radboudumc, Nijmegen, The Netherlands.
Clinical pharmacology and therapeutics
|February 27, 2024
概括
在20mg/kg的加重剂量后,每天45mg/kg的万科米辛连续输液剂量会导致EGFR≥50mL/min的患者过度暴露于药物. 建议使用较低的剂量和基于功能进行调整,以获得最佳的万科米辛治疗.
科学领域:
- 药理学和治疗学 药理学和治疗学
- 腎臟病學 (nephrology) 是一種醫學專業.
- 传染性疾病 传染性疾病
背景情况:
- 持续输液 (CI) 范科米辛比间歇输液提供了潜在的好处,包括减少毒性和改善目标实现.
- 范科米辛CI的最佳经验剂量尚不清楚,目前的治疗方案范围为30-60毫克/公斤/天.
- 精确的治疗药物监测 (TDM) 对于管理万科米辛治疗和预防毒性至关重要.
研究的目的:
- 在估计膜过率 (eGFR) ≥50mL/分钟的患者中,评估使用45mg/kg/天IC疗程的万科米辛暴露的充分性,其后是20mg/kg的负荷剂量.
- 评估这种剂量方案对万科米辛血度的影响,并确定影响暴露变异性的因素.
主要方法:
- 从接受CI的患者中回顾性分析康明的血度.
- 排除标准包括年龄在18岁以下,替代疗法,减少肌素清除量 (CKD-EPI<50mL/min/1.73m2) 和门诊抗生素治疗.
- 对每个样本进行了剂量,功能 (eGFR) 和血液抽取程序的评估;度≥40 mg/L的样本经过了对潜在的抽取错误的验证.
主要成果:
- 范科米辛度在18.4-61.0毫克/升之间,剂量为40-50毫克/公斤/天.
- 只有25%的样本位于17-25 mg/L的目标治疗窗口内,而15%的样本≥40 mg/L.
- 在89%的样本中观察到超治疗度 (≥40 mg/L),这些样本来自服用40-60 mg/kg/day剂量的患者,EGFR为50-80 mL/min.
结论:
- 经验证实的45mg/kg/day的万科米辛CI剂量方案导致EGFR≥50mL/min的患者过度暴露于药物.
- 建议包括使用较低的剂量和根据功能区分万科米辛剂量.
- 当度超过40 mg/L时,必须排除不正确的采样程序,并且患者间的显著变化强调了需要及时的TDM.
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