背景:药物-药物相互作用管理是复杂的。Nirmatrelvir/ritonavir是一种有效的细胞色素P450(CYP)3A抑制剂,并影响共同给药药物的药代动力学。虽然有一些关于尼马特雷韦/利托那韦的药物相互作用的报道,同时使用尼马特雷韦/利托那韦和另一种有效的CYP3A抑制剂对他克莫司的影响尚不清楚.这里,我们经历了一名患有2019年新型冠状病毒病(COVID-19)的肺移植患者。在这个病人身上,尼马特雷韦/利托那韦,伊曲康唑对CYP3A的抑制作用延长。
方法:我们介绍了一个四十多岁接受肺移植的病例。给予伊曲康唑和他克莫司1.0mg/d,谷值为8-12ng/mL。患者感染了COVID-19,并开始了尼马特雷韦/利托那韦治疗。在抗病毒治疗期间,他克莫司停药5d。尼马特雷韦/利托那韦治疗结束后,他克莫司以1.0mg/d恢复,但7d后的谷值高达31.6ng/mL。随后,患者再次停药36小时他克莫司,但波谷值仅降至16.0ng/mL。
结论:在服用伊曲康唑的患者中,通过对CYP3A的抑制作用,联合使用利托那韦导致他克莫司清除率的长期下降。药剂师对药物-药物相互作用的管理对于使用多种药物的患者可能很重要。
BACKGROUND: Drug-drug interaction management is complex. Nirmatrelvir/ritonavir is a potent cytochrome P450 (CYP) 3A inhibitor and influences pharmacokinetics of co-administered drugs. Although there are several
reports about drug-drug interactions of nirmatrelvir/ritonavir, an influence of a concomitant use of nirmatrelvir/ritonavir and another potent
CYP3A inhibitor on tacrolimus remains unclear. Here, we experienced a lung transplant patient with the novel coronavirus disease 2019 (COVID-19). In this patient, nirmatrelvir/ritonavir was administered, and the inhibitory effect of itraconazole on
CYP3A was prolonged.
METHODS: We present a
case in forties who had undergone lung transplantation. He was administered itraconazole and tacrolimus 1.0 mg/d, with a trough value of 8-12 ng/mL. The patient contracted the COVID-19, and a nirmatrelvir/ritonavir treatment was initiated. During the antiviral treatment, tacrolimus administration was discontinued for 5 d. Tacrolimus was resumed at 1.0 mg/d after completion of the nirmatrelvir/ritonavir treatment, but the trough value after 7 d was high at 31.6 ng/mL. Subsequently, the patient was placed on another 36-h tacrolimus discontinuation, but the trough value decreased to only 16.0 ng/mL.
CONCLUSIONS: Co-administration of ritonavir caused a prolonged decrease in tacrolimus clearance through its inhibitory effects on
CYP3A in a patient taking itraconazole. Management of drug-drug interaction by pharmacists can be important for patients with multiple medications.