顾永丽+陈元娜+叶晓芬+金美玲+蔡映云+吕迁洲

摘 要 1例72岁老年男性因肺曲霉感染入院，住院期间给予伏立康唑（威凡；首日400 mg，ivgtt，q12h；维持200 mg，ivgtt，q12h）抗真菌治疗，症状好转后出院，并予以伏立康唑片（威凡；200 mg，po，bid）序贯治疗。口服伏立康唑片期间患者反复出现发热，伴腹部肌肉痉挛性疼痛，而使用注射用伏立康唑时并无不适症状。结合患者用药情况，并追问患者病史，临床药师考虑上述症状是伏立康唑片剂中的辅料引起的过敏反应，故建议患者换用与伏立康唑片剂中辅料基本不同的泊沙康唑口服混悬液序贯治疗。一周后，电话随访患者，病情控制平稳，未出现类似过敏症状。

关键词 伏立康唑 过敏反应 临床药师

中图分类号：R978.5 文献标识码：C 文章编号：1006-1533（2017）01-0069-03

Clinical pharmacist-participating analysis of a case of voriconazole tablet allergy

GU Yongli1*， CHEN Yuanna2， YE Xiaofen3** JIN Meiling4 CAI Yingyun3， LV Qianzhou3（1. Department of Pharmacy， the First Peoples Hospital of Lianyungang City， Lianyungang 222022， China； 2. Department of Pharmacy， the Second Hospital of Yinzhou District， Ningbo 315040， China； 3. Department of Pharmacy， Zhongshan Hospital， Fudan University， Shanghai 200032， China； 4. Department of Respiratory Diseases， Zhongshan Hospital， Fudan University， Shanghai 200032， China）

ABSTRACT A 72 years old man was hospitalized due to pulmonary aspergillosis and was administered with 400 mg of voriconazole， ivgtt， q12h at the first day and then 200 mg， ivgtt， q12h for antifungal treatment during hospitalization， and voriconazole tablets were orally taken （200 mg， po， bid） for sequential treatment after he was discharged from the hospital. Recurrent fever with abdominal muscle spastic pain emerged during the oral administration of voriconazole tablets but not during the voriconazole for injection. Clinical pharmacist considered that the above symptoms were the allergic reactions caused by the accessories in voriconazole tablets based on the medical history of the patient and then suggested to use posaconazole oral suspension with different accessories instead of voriconazole tablets for sequential treatment. A week later， the patient was followed up by telephone and his condition was improved without adverse drug reactions.

KEY WORDS voriconazole； allergic reactions； clinical pharmacist

制剂辅料是指生产药品和调配处方时所用的赋形剂和附加剂，其功能除赋形外，还能保持或增加活性成分的稳定性和生物利用度[1]。辅料是非活性的，既不影响主药药理作用的发挥，又不与处方中其他组分或容器发生不良相互作用。因此，一出现药物不良反应，人们往往将其归于活性成分[2]。在临床治疗过程中，药物辅料引起的过敏反应往往容易被忽视，故临床药师在参与临床过程中不仅要关注药理学问题，还要关注可能由药物制剂因素引起的问题。本文通过报道1例由伏立康唑片剂中辅料引发过敏反应的病例，探讨临床药师在该类患者药学监护中应发挥的作用。

1 病例摘要

患者，男性，72岁。身高172 cm，体重73 kg。患者因“反复发热、咳嗽、咳痰2月余，加重10 d”入院。……