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发表于 2008-11-20 11:04:14
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126-6-第六节 他克莫司应用中的注意事项
大剂量FK506治疗时可引起心室或室间隔肥大,少数病例可发生心肌损害,降低剂量或停止给药可逆转。用药期间建议定期检查心电图、超声心动图等,尤其是合并心脏疾病、使用激素、高血压、肝肾功能不全,或水钠储留感染的患者。如果出现异常,应该考虑减量或者停药。 4 }+ T/ I9 z3 M2 k- |
; M J2 G1 x7 ? \) E0 r 用药期间应避免联合应用其他强效的免疫抑制剂,包括抗淋巴血清治疗。有报告在2岁以下EB病毒感染的儿童中,有增加淋巴组织异常增生的危险。因此,在用药前,最好进行EB病毒检查,并在治疗期间小心监测。 8 S# i1 ]( Q: c/ p$ W
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FK506可能引起高钾血症,所以不适用于高钾患者,肾功能异常者也应慎用,同时,用药期间应避免摄取高钾食物或使用保钾型利尿剂。 / P- T k0 k+ R; X9 t* n
& z0 s' D: S& j& _7 Z. I; r FK506浓缩输注液中含有聚乙烯氢化蓖麻油,曾报告会产生过敏反应,包括有皮肤潮红、呼吸困难、哮喘、血压下降及心动过速等。动物试验提示,若注射时减慢速度,或事先给予抗组胺药可降低过敏反应的发生率。
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应用FK506期间,应对以下方面进行监测:血常规、血肌醉、尿素氮、肝功能、电解质、血糖、凝血指标、血压、心电图和眼科检查。如有异常,必需调整剂量,甚至停药观察。
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参考文献:& u7 w9 }1 l/ [7 F) O) {
# v% I& E$ C! r6 R Assmann T, Homey B, Ruzicka T. Topical tacrolimus for thetreatment of inflammatory skin口iseases. Expert Opin Pharma-cother,2001.2(7) :1167一1175 0 \+ W3 _" r3 e; f$ ^' y
$ u9 b9 g% s {. l) ?
Bekersky I, Lilja H, Lawrence I. Tacrolimus pharmacology and nonclinical studies: from FK506 to protopic. Semin CutanMed Surg,2001.20(4):226一232
9 w" I) A3 m- H7 c) O% z3 R y; v% q2 B
Fam AG. Recent advances in the management of adultmyositis. Expert Opin Investig Drugs,2001.10(7):1265一1277
1 I% S2 A4 _ {; H4 f; {: d& x% Q* i7 a9 c& R
Gremillion RB, POsever JO, Manek N, et al. Tacrolimus inthe treatment of severe, refractory rheumatoid arthritis: initial ex-perience in 12 patients. j Rheumato1,1999.26(11) :2332一2336.
2 N/ X+ v$ @- U* X( y/ T. L# _# {1 ?# e7 c/ h
Heneghan MA, McFarlane IG. Current and novel immuno-suppressive therapy for autoimmune hepatitis. Hepatology,2002.35(1):7一13
8 p7 \) G; R5 ?4 b4 Z2 K* H1 `$ |- R& b. ^# X6 ]
Hunt SA. New immunosuppressive agents in clinical use: my-cophenolate mofetil and tacrolimus. Cardiol Rev, 2000. 8 (3):180一184 7 g8 h' z/ M3 T7 W a* v L
1 I$ ?' o- H, }# n2 B
Liu J, Farmer JD, Lane WS, et. al. Calcineurin is a commentarget of cyclophilin-cyclosporin A and FKBP-FK506 complex.Cell,1991. 66:807
4 _6 r: x0 J+ ?& C$ h
/ ]' h* ^7 f- K7 Z- s Morton SJ , Powell RJ. Cyclosporin and tacrolimus: their usein a routine clinical setting for scleroderma. Rheumatology ( Oxi-ford),2000.39(8):865一869
; M! z+ V. i' K% [9 o* l( M* w
1 Z# a6 A1 _* L! X) t9 L Oddis CV. Current approach to the treatment of polymyositisand dermatomyositis. Curr Opin Rheumatol,2000.12(6):492一497
& T% c8 G" i; j4 X7 K `, C, H7 q
Olyaei AJ,de Mattos AM, Bennett WM, et al. Nephrotoxici-ty of immunosuppressive drugs: new insight and preventive strate-gies. Curr Opin Crit Care, 2001.7(6) :384一389 0 o& q; G2 P V6 g& X+ D; e2 v$ a" [
3 Y! [) g8 b0 E$ \
Schreiber SL,Grabtree GR. The mechanism of action of Cy-closprine A and FK-506. Immunol Today, 1992. 13:136
, V% [& a9 L Y( _0 A4 f. B/ z6 W2 p4 w+ g H% Q* k
Thomas-Golbanov C, Sridharan S. Novel therapies in vasculi-tis. Expert Opin Investig Drugs, 2001.10(7):1279一1289
2 L; C6 E7 F6 v0 p! q
7 I. G8 v' n4 X! t Wassim Y, Almawi and Ohannes K. Melemedjian. Clinicaland mechanistic differences between FK506(tacrolimus) and cy-closporin A. Nephrol Dial Transplant, 2000.15:1916一1918
9 X6 F; C( P m! F% L
5 X5 e8 p! |. K$ k: p6 Z8 i, J Wong SH. Therapeutic drug monitoring for immunosup-pressants.Clin Chim Acts, 2001313(1一2):241一253 7 i1 s" p0 ]* V* f% W
$ D; |4 o+ }1 d
Yoshimasu T, Ohtani T, Sakamoto Y, et al. Topicaltacrolimus therapy for facial erythematous lesions of cutaneous lu-pus erythematosus and dermatomyositis. Eur J Dermatol, 2002. 12(I):50一52 |
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