慢性腎臟病患者的藥物劑量調整方式

Drug Dosing Adjustment in Patients With Chronic Kidney Disease

10.6340/KD.202312_35(4).0005

曾天佑(Tien-Yu Tseng)；林柏松(Paik-Seong Lim)

腎臟病 ； 藥物劑量 ； 藥物動力學 ； 腎絲球過濾率 ； chronic kidney disease ； drug dosing ； pharmacokinetics ； glomerular filtration rate

腎臟與透析

35卷4期（2023 / 12 / 01）

181 - 185

繁體中文;英文

當藥物進入身體，藥物濃度會受到藥物的吸收、分布、代謝和排除等因素影響。腎功能不全會多方面影響藥物的代謝。噁心會降低藥物吸收，水腫讓藥物濃度下降，受到抑制的細胞色素P450和腎絲球過濾率下降會讓藥物濃度增加。如果我們給予腎臟病患者不適當藥物劑量，藥物的毒性可能會產生，所以我們要根據患者腎功能給予適當藥物劑量。我們提供以下的方法：詢問患者病史、計算腎絲球過濾率、根據腎絲球過濾率調整藥物劑量、用藥後監控藥物濃度。

When drug was administered into the body, drug concentration is dependent on absorption, distribution, metabolism, and elimination. The effects of impaired kidney function on drug metabolism were complex. Nausea lowers drug absorption but low drug concentration was found in edematous patients. Inhibition of cytochrome P450 and reduced glomerular filtration rate increase drug concentration. Inappropriate drug dosing may cause toxicity in patients with chronic kidney disease. We must prescribe appropriate drug dosing according to renal function. We provide a step-by-step: history taking, glomerular filtration rate calculation, drug dosing adjustment, and therapeutic drug monitoring.