肾移植受者联合用药对他克莫司影响及其剂量调整策略

肾移植后患者极易出现不同类型的排斥反应，他克莫司是临床最主要的免疫制剂。但他克莫司代谢个体差异明显，同时因为侵袭性操作以及受者长期处于免疫抑制状态等，极易发生肾移植受者真菌感染，临床上常同时给予抗真菌感染药物如伏立康唑治疗。已知伏立康唑与他克莫司间存在明显的药物间相互作用，可引起严重的药物不良反应。因此，联合用药需要格外关注他克莫司血药浓度变化，应及时调整剂量。重点讨论肾移植受者他克莫司和伏立康唑联合使用的必要性及相互作用，其他药物对他克莫司代谢的影响，以及肾移植受者他克莫司剂量调整策略，旨在为临床治疗方案的合理制定提供参考。

Drug Interaction and Dose Adjustment Strategy of Tacrolimus in Renal Transplantation Recipients

Different types of rejection may occur after kidney transplantation, and tacrolimus has been used as the primary agent for immunosuppressive therapy. However, individual differences in tacrolimus metabolism are significant; besides, renal transplant recipients are prone to develop fungal infections due to invasive procedures and prolonged immunosuppression, so anti-fungal drugs such as voriconazole are often clinically used in combination with tacrolimus. There is obvious drug interaction between voriconazole and tacrolimus, which may lead to serious adverse drug reactions, therefore, it is necessary to pay special attention to the change in the blood concentration of tacrolimus and adjust the dosage timely. This paper summarizes the necessity and interaction of tacrolimus and voriconazole in renal transplantation recipients, the effects of other drugs on tacrolimus metabolism, and dose adjustment strategy of tacrolimus in kidney transplantation recipients, in order to provide reference for clinical therapeutic regimens.