Liver injury caused by the combination of voriconazole and nirmatrelvir/ritonavir
郭冬杰 1李朋梅 1王淑洁
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作者信息
1. 中日友好医院药学部，北京 100029
折叠
摘要
1例66岁男性肺移植术后患者，长期服用他克莫司、麦考酚钠、泼尼松三联药物抗排斥反应。因患者发生新型冠状病毒和肺部真菌感染，给予奈玛特韦/利托那韦（Paxlovid）抗病毒治疗，2 d后加用伏立康唑抗真菌治疗。加用伏立康唑前患者丙氨酸转氨酶34 U/L，天冬氨酸转氨酶28 U/L。伏立康唑与Paxlovid联用第4天，伏立康唑血药谷浓度16.06 mg/L，丙氨酸转氨酶176 U/L，天冬氨酸转氨酶166 U/L，立即停用伏立康唑，2 d后停用Paxlovid。伏立康唑停药5 d后，患者肝功能恢复正常；9 d后，其血药谷浓度为5.84 mg/L。考虑患者的肝损伤是伏立康唑与Paxlovid联用所致。 A 66-year-old male patient who underwent lung transplantation took a combination therapy with tacrolimus, mycophenolate sodium, and prednisone for a long time to resist rejection.Due to the occurrence of novel coronavirus and pulmonary fungal infection,the patient was given antiviral therapy with nirmatrelvir/ritonavir (Pavlovid), followed by antifungal therapy with voriconazole 2 days later. Before voriconazole treatment, the patient′s alanine aminotransferase was 34 U/L, and aspartate aminotransferase was 28 U/L. On the 4th day of the combination of voriconazole and Paxlovid, the patient′s blood trough concentration of voriconazole was 16.06 mg/L, alanine aminotransferase was 176 U/L, and aspartate amino- transferase was 166 U/L. Voriconazole was discontinued immediately and 2 days later,Paxlovid was discontinued. Five days after discontinuation of voriconazole, the patient′s liver function returned to normal 9 days later, blood trough concentration of voriconazole was 5.84 mg/L. It was considered that the patient′s liver injury was caused by the combination of voriconazole and Paxlovid.
Abstract
A 66-year-old male patient who underwent lung transplantation took a combination therapy with tacrolimus, mycophenolate sodium, and prednisone for a long time to resist rejection.Due to the occurrence of novel coronavirus and pulmonary fungal infection,the patient was given antiviral therapy with nirmatrelvir/ritonavir (Pavlovid), followed by antifungal therapy with voriconazole 2 days later. Before voriconazole treatment, the patient′s alanine aminotransferase was 34 U/L, and aspartate aminotransferase was 28 U/L. On the 4th day of the combination of voriconazole and Paxlovid, the patient′s blood trough concentration of voriconazole was 16.06 mg/L, alanine aminotransferase was 176 U/L, and aspartate amino- transferase was 166 U/L. Voriconazole was discontinued immediately and 2 days later,Paxlovid was discontinued. Five days after discontinuation of voriconazole, the patient′s liver function returned to normal 9 days later, blood trough concentration of voriconazole was 5.84 mg/L. It was considered that the patient′s liver injury was caused by the combination of voriconazole and Paxlovid.
关键词
抗病毒药/抗真菌药/化学及药物性肝损伤/伏立康唑/药物相互作用/肺移植/利托那韦/奈玛特韦
Key words
Antiviral agents/Antifungal agents/Chemical and drug induced liver injury/Voriconazole/Drug interactions/Lung transplantation/Ritonavir/Nirmatrelvir
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