著者

福田 裕子 田中 裕貴子 森田 貴子 中永 あやこ 道下 佳子 中蔵 伊知郎 北澤 文章 辻川 正彦

出版者

一般社団法人日本医療薬学会

雑誌

医療薬学 (ISSN:1346342X)

巻号頁・発行日

vol.47, no.5, pp.264-271, 2021-05-10 (Released:2022-05-18)

参考文献数

19

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We experienced two cases with mild to moderate renal dysfunction in which amantadine hydrochloride (amantadine) intoxication was followed by increases in its blood levels. Case 1 was a patient with mild to moderate renal dysfunction [estimated glomerular filtration rate (eGFRcreat): 48.9 mL/min/1.73m2; glomerular filtration rate (GFR) category: G3a] taking amantadine 300 mg daily. In Case 1, the blood level of amantadine at 13 hours and 30 mins after administration was 2,368 ng/mL, pyrexia, myoclonus, and psychological symptoms were observed. After discontinuing amantadine, the patient’s myoclonus improved, but he died of acute respiratory distress syndrome. Case 2 was a patient with mild to moderate renal dysfunction [eGFRcreat: 55.6 mL/min/1.73m2; GFR category: G3a] taking amantadine 100 mg daily. In the patient, pyrexia, myoclonus, and consciousness disorder were observed. The blood level of amantadine 88 hours after the last dose was 265 ng/mL, and the blood level that was collected 24 hours after the end of administration was estimated to be about 2,600 to 4,200 ng/mL. In all cases, the clinical features were consistent with the common symptoms of amantadine intoxication, and improved by discontinuing amantadine. Taken together, these findings suggest that the patients were intoxicated with amantadine. These results indicate that amantadine intoxication due to elevated blood levels also occurs in patients with mild to moderate renal dysfunction during the administration of the usual dose of amantadine. In addition, the measurement of amantadine blood levels may be useful in avoiding amantadine intoxication.

著者

中蔵 伊知郎 木原 理絵 阿部 正樹 河合 実 関本 裕美 廣畑 和弘 山内 一恭 小森 勝也

出版者

一般社団法人 日本腎臓病薬物療法学会

雑誌

日本腎臓病薬物療法学会誌 (ISSN:21870411)

巻号頁・発行日

vol.2, no.1, pp.11-16, 2013 (Released:2018-04-02)

参考文献数

8

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liposomal amphotericin Bは、低カリウム血症の発生が問題となる。L-AMB投与による低カリウム血症の発現頻度が腎機能の程度によって異なるか否かを明らかにすることを目的とし、我々は、L-AMBによる低カリウム血症の発現頻度を腎機能別で確認したので報告する。国立病院機構大阪医療センターにおいて、L-AMBを3日以上投与された成人の入院患者46名を対象とした。今回の検討では、腎機能の程度によらず、低カリウム血症の発現が認められた。また、腎代替療法を施行されている患者においても低カリウム血症が認められた。しかし、腎機能別での発症頻度に差はなかった。このため、L-AMBを使用する際には、腎機能の程度に関係なく、早期から血清カリウム値のモニタリングをすることが望ましい。

著者

山下 大輔 和田 恭一 吉牟田 剛 森 英人 中蔵 伊知郎 堀部 明美 岡田 博 佐田 誠 岡島 年也 塘 義明 野々木 宏 小原 延章

出版者

一般社団法人日本医療薬学会

雑誌

医療薬学 (ISSN:1346342X)

巻号頁・発行日

vol.36, no.5, pp.323-327, 2010 (Released:2012-03-09)

参考文献数

13

被引用文献数

1

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The purposes of this study were to demonstrate how the interaction between rifampicin and voriconazole can be managed clinically and to characterize the changes in voriconazole concentration levels after discontinuation of rifampicin.The concomitant administration of voriconazole and rifampicin is contraindicated because the interaction between these drugs results in a subtherapeutic concentration of voriconazole.In this regard,voriconazole is known to be metabolized by CYP2C19,2C9,3A4,and rifampicin is a potent inducer of CYP3A4.The interaction between rifampicin and voriconazole was investigated in a 70 year old male patient with severe infection in a prosthetic graft,necessitating simultaneous treatment with vancomycin and rifampicin.Rifampicin therapy was discontinued to start antifungal treatment with voriconazole.Interaction between the 2 drugs was evaluated by measuring voriconazole trough levels 4,7,11,18,and 29 days after starting therapy with it,performing the assays by high-performance liquid chromatography.Four days after starting voriconazole,we observed a significant decrease in its serum concentration,to 0.24μg/mL.After 7 days,it had increased to 0.84μg/mL and to 1.24μg/mL after 11 days,and thereafter,continued to gradually increase.Thus,after discontinuing rifampicin,CYP induction continued to be strong for the first 11 days and then became more moderate over the course of a month.In conclusion,it is essential that patients being treated with both rifampicin and voriconazole have their voriconazole concentrations monitored when rifampicin therapy is discontinued.