注射用伏立康唑致自杀倾向与感觉异常1例分析

doi:10.19803/j.1672-8629.20220533

摘要/Abstract

摘要： 目的分析伏立康唑致自杀倾向与感觉异常不良反应的原因及相关文献复习,为其安全使用提供参考。方法分析1例肺部感染患者使用注射用伏立康唑治疗后出现自杀倾向同时伴有痛觉消失与味觉异常的病例,通过查阅国内外相关文献,结合监测患者伏立康唑的谷浓度和CYP2C19基因型及相关指标,分析发生不良反应的原因。结果患者CYP2C19基因型为快代谢型,伏立康唑谷浓度为5.12 mg·L-1。伏立康唑致自杀倾向与感觉异常不良反应的原因与肝功能、炎性指标及白蛋白情况等因素相关。结论高龄患者使用伏立康唑时应尽早监测血清药浓度和测定代谢酶基因类型,密切监测肝功能、炎性指标及营养情况,及时制定个体化给药方案,以避免伏立康唑导致的精神-神经系统不良反应。

关键词: 伏立康唑, 自杀倾向, 痛觉消失, 味觉异常, 药品不良反应, 肝功能, 炎性指标, 白蛋白情况

Abstract: Objective To analyze the causes of suicidal tendency and paresthesia induced by voriconazole and review the related literature so as to provide reference for safe use of this drug. Methods The clinical data on one patient with both pulmonary infection and suicidal tendency accompanied by nociception and abnormal taste who was treated with voriconazole for injection was analyzed. By reviewing relevant literature at home and abroad, and based on the trough concentration of voriconazole, CYP2C19 genotype and related indicators, the causes of adverse reactions were analyzed. Results CYP2C19 genotype was of the fast metabolic type, and the trough concentration of voriconazole was 5.12 mg·L-1.The causes of suicidal tendency and paresthesia induced by voriconazole were related to liver function, inflammatory indicators and albumin status. Conclusion Serum concentrations and metabolic enzyme gene types should be detected as soon as possible in elderly patients using voriconazole. Liver function, inflammatory indicators and nutritional status should be closely monitored. Individualized administration regimens should be formulated immediately to prevent psycho-nervous system adverse reactions caused by voriconazole.

Key words: voriconazole, suicide tendency, nocieption, abnormal taste, adverse drug reaction, liver function, inflammatory indicators, albumin status

中图分类号:

R978
R994.11

胡碧原, 汪静, 郑微旗, 胡宏平, 陈泳伍. 注射用伏立康唑致自杀倾向与感觉异常1例分析[J]. 中国药物警戒, 2023, 20(4): 469-472.

HU Biyuan, WANG Jing, ZHENG Weiqi, HU Hongping, CHEN Yongwu. Suicidal tendency and paresthesia induced by voriconazole: a case report[J]. Chinese Journal of Pharmacovigilance, 2023, 20(4): 469-472.

参考文献

[1] CORNELY OA, BASSETTI M, CALANDRA T, et al.ESCMID guideline for the diagnosis and management of Candida diseases 2012: non-neutropenic adult patients[J]. Clinical Microbiology and Infection: The Official Publication of the European Society of Clinical Microbiology and Infectious Diseases, 2012,18(7): 19-37.
[2] KEN C, XIANGLIN Z, XIAOYAN K, et al.Individualized medication of voriconazole: a practice guideline of the division of therapeutic drug monitoring, Chinese Pharmacological Society[J]. Therapeutic Drug Monitoring, 2018, 40(6): 663-674.
[3] CHENG L, LIANG ZM, LIU ZR, et al.Clinical characteristics of voriconazole- induced neurological ADR and the occurrence of hypokalemia and hyponatremia[J].Chinese Journal of Hospital Pharmacy(中国医院药学杂志), 2022, 42(2): 439-442.
[4] CHENG L, LIANG ZM, LIU ZR, et al.Clinical characteristics of voriconazole-induced neurological ADR and the occurrence of hypokalemia and hyponatremia[J]. China Pharmacy(中国药房), 2021, 32(20): 2520-2524.
[5] LIAO SY, MEI ZR, DENG YH,et al. Pharmaceutical care of clinical pharmacist for severe mental disorder induced by voriconazole and literature review[J/OL]. Pharmacy Today(今日药学).[2022-10-01].http://kns.cnki.net/kcms/detail/44.1650.R.20220906.1528.006.html.
[6] BAYHAN GI, GARIPARDIC M, KARAMAN K, et al.Voriconazole-associated visual disturbances and hallucinations[J]. Cutaneous and Ocular Toxicology, 2016, 35(1): 80-82.
[7] ZHENG R, LI Y, GUO C, et al.Voriconazole induced hallucinations and visual disturbances in a female child: a case report and literature review[J]. Frontiers in Pediatrics, 2021, 9: 655327.
[8] ZHANG XJ, YANG HX, GUO XB, et al.Adverse Reactions of visual disturbances and hallucinations induced by voriconazole tablets in two cases and related literature review[J]. Chinese Journal of Pharmacovigilance(中国药物警戒), 2021, 18(6): 588-591.
[9] EIDEN C, PEYRIÈRE H, COCIGLIO M, et al. Adverse effects of voriconazole: analysis of the french pharmacovigilance database[J]. Annals of Pharmacotherapy, 2007, 41(5): 755-763.
[10] DOLTON MJ, RAY JE, CHEN SCA, et al.Multicenter study of voriconazole pharmacokinetics and therapeutic drug monitoring[J]. Antimicrobial Agents and Chemotherapy, 2012, 56(9): 4793-4799.
[11] BECK AT, BECK RW.Screening depressed patients in family practice: a rapid technic[J]. Postgraduate Medicine, 1972, 52(6): 81-85.
[12] DADFAR M, LESTER D, ATEF VAHID MK.Psychometric characteristics of the wish to be dead scale (WDS) in Iranian psychiatric outpatients[J]. Current Psychology, 2018, 37(3): 498-507.
[13] CHI W, LEE HJ, CHONG YP.Comparison of prospective and retrospective methods of a tigecycline post-marketing surveillance study in the safety outcomes of patients with complicated skin structure infection, complicated intraabdominal infection and community-acquired pneumonia[J]. Infectious Diseases and Therapy, 2021, 10(1): 411-420.
[14] RUAN ZJ, LIU C,SHI H, et al.Analysis of clinical adverse reaction of fosfomycin sodium injection and current situation of fosfomycin combined with Traditional Chinese medicine[J]. Chinese Journal of Antibiotics(中国抗生素杂志), 2022, 47(9): 971-976.
[15] FU LM, ZHU P.Observation of curative effect of atomizing inhalation of amikacin in the treatment of severe community-acquired pneumonia in the elderly[J]. Journal of Capital Medical University(首都医科大学学报), 2018,39(3): 428-432.
[16] NARANJO CA, BUSTO U, SELLERS EM, et al.A method for estimating the probability of adverse drug reactions[J]. Clinical Pharmacology and Therapeutics, 1981, 30(2): 239-245.
[17] THEURETZBACHER U, IHLE F, DERENDORF H.Pharmacokinetic/pharmacodynamic profile of voriconazole[J]. Clinical Pharmacokinetics, 2006, 45(7): 649-663.
[18] DAI TT,HU L,LI TM,et al.Discussion of the correlation between voriconazole's trough concentration and mental abnormity rate[J]. Chinese Pharmaceutical Journal(中国药学杂志), 2018, 53(5): 375-378.
[19] DOLTON MJ, RAY JE, CHEN SCA, et al.Multicenter study of voriconazole pharmacokinetics and therapeutic drug monitoring[J]. Antimicrobial Agents and Chemotherapy, 2012, 56(9): 4793-4799.
[20] JIN H, WANG T, FALCIONE BA, et al.Trough concentration of voriconazole and its relationship with efficacy and safety: a systematic review and meta-analysis[J]. Journal of Antimicrobial Chemotherapy, 2016, 71(7): 1772-1785.
[21] CHENG L, XIANG R, LIU F, et al.Therapeutic drug monitoring and safety of voriconazole in elderly patients[J]. International Immunopharmacology, 2020, 78: 106078.
[22] VREUGDENHIL B, VAN DER VELDEN WJFM, FEUTH T, et al. Moderate correlation between systemic IL-6 responses and CRP with trough concentrations of voriconazole[J]. British Journal of Clinical Pharmacology, 2018, 84(9): 1980-1988.
[23] XU BF, CHEN SY, ANG W, et al.Impact of hypoproteinemia on plasma trough concentration_of voriconazole in critically ill patients[J]. Chinese Journal of New Drugs(中国新药杂志), 2019, 28(3): 308-313.
[24] HAANING N, DAMSGAARD EM, MOOS T.The blood-brain barrier in ageing persons[J]. Ugeskrift for Laeger, 2018, 180(13): V08170576.
[25] GALEA I.The blood-brain barrier in systemic infection and inflammation[J]. Cellular & Molecular Immunology, 2021, 18(11): 2489-2501.
[26] HAMADA Y, UEDA T, MIYAZAKI Y, et al.Effects of antifungal stewardship using therapeutic drug monitoring in voriconazole therapy on the prevention and control of hepatotoxicity and visual symptoms: a multicentre study conducted in Japan[J]. Mycoses, 2020, 63(8): 779-786.
[27] LIN ZQ, ZHANG QQ, CHEN TT.Therapeutic drug monitoring of voriconazole: an overview of relevant guidelines at home and abroad[J]. Adverse Drug Reactions Journal(药物不良反应杂志), 2020, 22(7): 409-415.
[28] MIKUS G, SCHOLZ IM, WEISS J.Pharmacogenomics of the triazole antifungal agent voriconazole[J]. Pharmacogenomics, 2011, 12(6): 861-872.
[29] ZHANG Y, HOU K, LIU F, et al.The influence of CYP2C19 polymorphisms on voriconazole trough concentrations: systematic review and meta-analysis[J]. Mycoses, 2021, 64(8): 860-873.
[30] LEE J, NG P, HAMANDI B, et al.Effect of therapeutic drug monitoring and cytochrome P450 2C19 genotyping on clinical outcomes of voriconazole: a systematic review[J]. The Annals of Pharmacotherapy, 2021, 55(4): 509-529.
[31] GAUTIER-VEYRET E, FONROSE X, TONINI J, et al.Variability of voriconazole plasma concentrations after allogeneic hematopoietic stem cell transplantation: impact of cytochrome P450 polymorphisms and comedications on initial and subsequent trough levels[J]. Antimicrobial Agents and Chemotherapy, 2015, 59(4): 2305-2314.
[32] HAMADEH I S, KLINKER KP, BORGERT SJ, et al.Impact of the CYP2C19 genotype on voriconazole exposure in adults with invasive fungal infections[J]. Pharmacogenetics and Genomics, 2017, 27(5): 190-196.
[33] LEVINE MT, CHANDRASEKAR PH.Adverse effects of voriconazole: over a decade of use[J]. Clinical Transplantation, 2016, 30(11): 1377-1386.
[34] WANG T, YAN M, TANG D, et al.Using Child-Pugh class to optimize voriconazole dosage regimens and improve safety in patients with liver cirrhosis: insights from a population pharmacokinetic model-based analysis[J].Pharmacotherapy, 2021, 41(2): 172-183.