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.

著者

和田 恭一

出版者

一般社団法人 日本臓器保存生物医学会

雑誌

Organ Biology (ISSN:13405152)

巻号頁・発行日

vol.24, no.1, pp.13-19, 2017 (Released:2017-03-31)

参考文献数

11

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One year-mortality of end-stage heart failure is about 50%, which is comparable to those of terminal cancers. Recently, new curriculum for specialists of clinical pharmacology for chemotherapy of cancer has been released. Likewise, we need to create specialized clinical pharmacists for the management of end-stage heart failure.These pharmacists will be called as “Transplant Pharmacist”. In this article, we will outline our effort as the special team for the management of the patients waiting for heart transplant and the post-heart transplant patients. Transplant pharmacists will play a pivotal role in this team activity. Prevention of thromboembolism in the patients with left ventricular assist device (LVAD) needs close therapeutic drug monitoring (TDM) and rapid feedback of data on warfarin. In addition to these actions, successful management of warfarin requires that the transplant pharmacists effectively counsel and educate these patients with LVAD. TDM of antibiotic drugs is also essential for treatment of infection with LVAD. On the other hand, immunosuppressant like cyclosporine, tacrolimus, mycophenolate mofetil and evelolimus have critical influence on graft rejection as well as susceptibility to infection. Transplant pharmacists should evaluate effective the plasma concentration of those drugs through Parmacokinetics/Pharmacodynamics (PK/PD). Immunosuppressant adherence is also a critical issue to heart transplant recipient. Therefore, constant counseling and educating to these patients from transplant pharmacists are necessary.Transplant pharmacists skilled at PK/PD and TDM of cardiovascular, antibiotic and immunosuppressive drugs would be key talents in highly-sophisticated medicine in the future.

著者

和田 恭一 保田 智恵子 花房 小百合 高田 充隆 柴川 雅彦

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.28, no.5, pp.468-472, 2002-10-10 (Released:2011-03-04)

参考文献数

9

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Fluvoxamine, a selective serotonin reuptake inhibitor (SSRI), is widely used in the treatment of patients with depression. It is known that fluvoxamine inhibits the activity of human cytochrome P450 enzymes (CYP) responsible for the oxidative metabolism of many drugs. Inhibition of CYP results in a number of clinically important pharmacokinetic drug interactions.Therefore, the interaction between warfarin and fluvoxamine was evaluated. The patients treated with fluvoxamine were selected from the prescription database file made for the prescriptions order entry system, which contains all the prescriptions filled for the inpatients and outpatients. There were 106 patients treated with fluvoxamine between July 2000 and June 2001. Of 106 patients, 20 used warfarin concomitantly during the study period. Increased INR/Dose values were observed in all patients after the initiation of fluvoxamine therapy. Subsequently, the high INR/Dose values were observed during the concomitant use of warfarin and fluvoxamine (P<0.01). It is suggested that the increase in the anticoagulant activity of warfarin occurred when fluvoxamine is used concomitantly. Therefore, frequent coagulation tests are required in patients treated with warfarin after the initiation or discontinuation of fluvoxamine therapy. In conclusion, warfarin should be used with worry when fluvoxamine is used concomitantly.