警惕!阿奇霉素配伍禁忌和相互作用

2018-05-10 Gcplive 药评中心

阿奇霉素对革兰阴性菌的抗菌活性是红霉素的2~8倍(抗革兰阳性菌的活性比红霉素略差),对肺炎支原体的作用是大环内酯类中的最强者。阿奇霉素的组织浓度较同期血药浓度高出10~100倍,炎症部位浓度比非炎症部位高达6倍以上。阿奇霉素血浆半衰期35~48h,患者口服用药依从性好。

阿奇霉素对革兰阴性菌的抗菌活性是红霉素的2~8倍(抗革兰阳性菌的活性比红霉素略差),对肺炎支原体的作用是大环内酯类中的最强者。阿奇霉素的组织浓度较同期血药浓度高出10~100倍,炎症部位浓度比非炎症部位高达6倍以上。阿奇霉素血浆半衰期35~48h,患者口服用药依从性好。

一、阿奇霉素给药说明

1、口服给药:口服制剂应在餐前1小时或餐后2小时服用。(希舒美除外,可与食物同时服用);

2、注射液的配制: 首先用适量注射用水充分溶解,配制成100mg/ml溶液,再加入250ml或500ml的0.9%氯化钠注射液或5%葡萄糖注射液中,最终配制成1-2mg/ml的静脉滴注液。

3、静脉滴注: 每500mg本药静脉滴注时间不宜少于60分钟,药液浓度为1mg/ml时滴注时间应为3小时,浓度为2mg/ml时滴注时间应为1小时,滴注液浓度不得高于2mg/ml。

4、阿奇霉素注射剂不宜静脉推注或肌内注射给药。

二、阿奇霉素配伍禁忌

特别提醒1:

药品说明书:阿奇霉素不宜其他静脉内输注物、添加剂、药物配伍,也不能同时在同一条静脉通路中滴注。

文献报道,654-2(山莨菪碱)或维生素B6与阿奇霉素混合滴注,可以有效减少阿奇霉素所引起的胃肠道反应。虽然未发现654-2、维生素B6与阿奇霉素存在配伍禁忌,为避免医患纠纷,不建议混合滴注。

特别提醒2:

阿奇霉素和氨溴索存在配伍禁忌,不宜混合滴注。国内文献报道的与阿奇霉素有明确配伍禁忌的药物有:



三、阿奇霉素的相互作用

1、药代动力学相互作用

大环内酯类抗菌药物,如红霉素、克拉霉素对肝药酶CYP1A2和CYP3A4有明显的抑制作用;阿奇霉素、地红霉素对肝药酶的影响很小,因此几乎不发生相互作用。

2、药效学相互作用

阿奇霉素有肝功能异常,肝炎,胆汁淤积性黄疸,肝坏死以及肝衰竭的报道,其中某些病例可能致死。当与其它有肝损害作用的药物合用,应注意观察肝炎症状和体征。

阿奇霉素可引起心室复极化和QT间期延长。如果与其它已知可延长 QT 间期药物,如抗精神病药物、抗抑郁药物、氟喹诺酮类药物合用时,有发生心律失常和尖端扭转型室性心动过速的风险。


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    2018-06-14 Alexander

    非常感谢.特别是混合滴注禁忌.

    0

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    2018-05-12 ylz8405
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    2018-05-10 执着追梦

    学习.谢谢分享

    0

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