運用腎臟排除藥物監測系統進行病人用藥安全監測——metformin

The Preliminary Report on Factors of Prolonged Weaning of Respiratory Failure Patients

目的：當metformin 使用於腎功能不全病人，亦會增加發生乳酸中毒風險。運用「腎臟排除藥物監測（Renal excreted Drug Monitoring, RDM）系統」，由臨床藥師介入照護，以降低藥物不良反應發生。方法：自2012 年5 月至2013 年8 月在南部某區域醫院監測metformin、glimepiride/metformin、glyburide/metformin、sitagliptin/metformin，利用RDM 系統搜尋住院病人，當血中肌酸酐＞ 1.5mg/dL 且使用劑量不正確者，臨床藥師積極與醫師討論提供適當建議，並進行建議事項接受度統計資料分析。結果：本研究共評估605 人次，用藥建議處方數186 件，接受用藥建議結果，最主要為再次抽血追蹤腎功能且檢驗數值結果正常43.1%，其次為停用藥物35.4%及更改其他口服降血糖藥物或胰島素取代21.5%。在臨床藥事介入服務接受度為84.9%。結論：運用RDM 系統可提供臨床藥師進行監測與即時劑量建議，確實降低病人因腎功能不全所造成之不良反應與藥物毒性。

If metformin is used in patients with renal impairment, it could increase the risk of lactic acidosis. With the assistance of pharmacists in the clinical care of patients, a renal excretion drug monitoring (RDM) system was developed which can improve the appropriateness of drug prescriptions and reduce the incidence of adverse drug reactions. Methods: In this study, four drugs (metformin, glimepiride/metformin, glyburide/ metformin, and sitagliptin/metformin) and laboratory data were collected from inpatients using the RDM system between May 2012 and August 2013 in a regional hospital in southern Taiwan. When the serum creatinine was > 1.5 mg/dL and the dosage of drug was inappropriate, clinical pharmacists provided a dosage recommendation to the physicians and conducted statistical analysis of acceptance rates. Results: A total 605 patients were screened by this system. Among the pharmacists’ recommendations, it was suggested that 186 prescriptions be monitored for renal function (43.1%), discontinued (35.4%), and switched to other oral hypoglycemic agents or insulin (21.5%). The acceptance rate of pharmacist interventions was 84.9%. Conclusions: The RDM system may be helpful for clinical pharmacists and real-time renal dose adjustment suggestions, as well as to minimize adverse drug reactions and toxicities associated with renal dysfunction.