PPI的药理学基础和联合应用x-药学部秦玉花重点分析.pptVIP

PPIs also may competitively inhibit CYP2C19 metabolism. In vitro testing of a model substrate showed that lansoprazole and omeprazole were the most potent inhibitors, whereas pantoprazole and rabeprazole were the least potent。 Am J Gastroenterol 2010; 105:34–41 1.增加剂量; 2. 改用对CYP2C19影响小的PPIs,如雷贝拉唑或泮托拉唑,消除不良的药物相互作用; 3.可改用H2受体阻滞剂雷尼替丁法莫替丁，不能选用西咪替丁; 4.加用糖蛋白Ⅱb/Ⅲa受体阻滞剂,如依替非巴肽等; 5.适当调整治疗方案。 6.更换新药:如普拉格雷(Prasugrel),替加瑞洛等; 7.有条件用前检测基因; 8.尽快修改说明书,尤其是OTC的奥美拉唑说明书。 奥美拉唑血浓度显著受CYP2C19基因多态性影响 Pharmacogenomics 2007;8:1199–1210 E E E PPIs又是2C19的抑制剂且能力各异 * 抑制能力依次是奥美拉唑兰索拉唑埃索拉唑潘托拉唑≈雷贝拉唑! PPI与临床常用的药