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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。 : y$ z8 c# G2 h! K2 l! q/ ?
, N+ K+ c, H; C+ t* ^ 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。
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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。 / r2 z# ~, t0 J6 |2 L
. G5 y8 [: z5 P3 l6 q( b3 j 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。 6 A0 i' r# u: e, F r1 [5 P& t
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参考文献:
8 a; w8 {7 @# \6 V `5 }
, o5 F8 ^, z* i' \: m 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
! ~( C% X3 r8 Y- A
1 f& C( l0 A3 x 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
2 {8 S! H3 ~0 g0 Z; d/ S
" A6 \* X; C% ` Fam AG. Recent advances in the management of adultmyositis. Expert Opin Investig Drugs,2001.10(7):1265一1277
. m# d1 E0 v, b, u- m3 W, \
0 B1 I3 j# ^ {7 Z& o( p. a. H 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.
5 w4 `$ m7 d. ^3 L- M9 s) m7 p* X" z
$ u$ _2 A% K& s% U' D/ p7 q6 p Heneghan MA, McFarlane IG. Current and novel immuno-suppressive therapy for autoimmune hepatitis. Hepatology,2002.35(1):7一13
/ Y% l# d0 f2 d0 W
* s2 N& ?$ z2 L3 I6 b Hunt SA. New immunosuppressive agents in clinical use: my-cophenolate mofetil and tacrolimus. Cardiol Rev, 2000. 8 (3):180一184
; Z2 }) f, U# R: [) z5 Z) U/ _$ a. g" \: H1 L& g) O
Liu J, Farmer JD, Lane WS, et. al. Calcineurin is a commentarget of cyclophilin-cyclosporin A and FKBP-FK506 complex.Cell,1991. 66:807
3 i3 i9 }) ^* S. G" h1 L; h8 B+ }# K& \7 M8 T
Morton SJ , Powell RJ. Cyclosporin and tacrolimus: their usein a routine clinical setting for scleroderma. Rheumatology ( Oxi-ford),2000.39(8):865一869 " F6 u, H3 x0 X7 X6 C
7 v( |7 I# K1 H: U9 {0 e0 K Oddis CV. Current approach to the treatment of polymyositisand dermatomyositis. Curr Opin Rheumatol,2000.12(6):492一497
0 D1 f: F& W3 o* @8 F# S5 E- X9 v |" f+ n2 v [- K+ c# m8 \/ \
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 5 |/ V( }1 B8 W- \
! M" i3 h6 _6 T6 {+ G
Schreiber SL,Grabtree GR. The mechanism of action of Cy-closprine A and FK-506. Immunol Today, 1992. 13:136
& S# \& S) H, K9 ~
4 d# Z0 B' _8 W* m2 u9 _0 T. n# A: U! P Thomas-Golbanov C, Sridharan S. Novel therapies in vasculi-tis. Expert Opin Investig Drugs, 2001.10(7):1279一1289 4 c8 i0 i h/ K$ y* d' K! m
1 F# M4 s6 L4 J. P6 l
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 % p- Y L5 L9 r7 Q' B
$ s! z8 E1 K1 t z6 r G
Wong SH. Therapeutic drug monitoring for immunosup-pressants.Clin Chim Acts, 2001313(1一2):241一253
5 e7 J Z6 w0 A5 A6 p* M2 y6 o. h. m: w' u
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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