Philip%20D.%20Hansten,?????

1
???????? 5602002?10?2?

• Philip D. Hansten,?????
• ??,?????????

2
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• ????(????)
• ?CYP3A4??????????
• Mebefradil(?????Posicor)
• ????????????????

3
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Doucet J et al. J Am Geriatr Soc. 1996944948.
4
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Scott MA et al. Am J HealthSyst Pharm.
199956189091
5
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Hansten PD, Horn JR. Modified from James Reason,
Human Error, 1990
10
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Hansten PD, Horn JR. Modified from James Reason,
Human Error, 1990
11
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Hansten PD, Horn JR. Modified from James Reason,
Human Error, 1990
12
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• ??????????????????5-?????????????????????????????
  
• ???5-???????????????5-???

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De Abajo FJ et al. Br Med J 19993191106-1109
13
????(?????Biaxin)????????

• 70????????0.25mg/?,??4??,????????
• 4??,??????????????????????????
• ????? 5.4ng/mL

Trevedi S et al. Ann Intern Med 1998 128604.
Letter
14
P-???(P-gp)

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Kovarik JM et al. Clin Pharmacol Ther 1999
66391-400
15
P-???(PGP)???????????
16
P-??????????????

• P-????????????????
• ???????
• ??????
• ??????
• ???????????

Tanigawara. Ther Drug Monit 2000 22 137-140.
17
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• ?14????????????,??????4?,????????
• ??????48mg
• ????60mg
• ???????????????,???????????

???????????(AUC)
???????? ??????????
LebrunVignes B. Br J Clin Pharmacol. 2001 51
443-450.
18
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Hansten PD, Horn JR. Modified from James Reason,
Human Error, 1990
19
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• ??????????????2250???

20
??????????(?????Zocor)???

• 16???????????900mg/?14??,????10mg????
• ??????????(AUC)???????????
• ??CYP3A4?P-????
• ????????

??????????(AUC)
?????? ????????
Sugimoto K et al. Clin Pharmacol Ther 2001 70
518-24.
21
??????CYP3A4??

• 12???????????????900mg/?14?
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• ???(2D6)
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Wang Z et al. Clin Pharmacol 2001 70 317-26.
22
??????????(?????Invirase)???

• 9???????????????20??,??????1200mg????
• ???????????????
• ????????????(AUC)?51????

?????????(AUC)
3500
3000
2500
2000
1500
1000
500
0
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????r??
Piscitelli SC et al. 8th Conf. On Retroviruses,
2001, Abst, 743
23
???(?????Advil)?????????????

• ????????81mg?????(ASA)6?,???3???????????
• 400mg?ASA??2??(?ASA???????)
• 400mg?ASA??2??(?ASA???)
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• ??????????????????
• ????(??)25mg?ASA?????
• ???? DR 75mg????(ASA??2???10??)
• ???1000mg?ASA?????

CatellaLawson F et al. New Engl J Med, 2001
345 1809-17.
24
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Hansten PD, Horn JR. Modified from James Reason,
Human Error, 1990
25
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• 10??????????600mg/?5??,????40mg????
• ?????????(AUC)??93
• ???????????????????

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18
16
14
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Kyrklund et al. Clin Pharmacol Ther 2000 68
592-597.
26
????(PHT,CBZ)?????(?????Zoloft)??

• ?????????(PHT)??????(CBZ)?9????54?????????????sert
  raline??
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???C/D?
100
80
60
40
20
0
?????
??????
Pihlsaard M, Eliasson E. Eur J Clin Pharmacol
2002 57 915-916.
27
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• 30?HIV????????????????????????
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• Chen???????(1998)

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700
600
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200
100
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Hillebrand-Haverkort et al. AIDS 1999 13 1803.
28
Fluticazone?CYP3A4??????

• Fluticasone?CYP3A4??????????
• ???Fluticasone??????12?26
• CYP3A4??????????fluticasone?????

29
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Hansten PD, Horn JR. Modified from James Reason,
Human Error, 1990
30
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??Hanston, Science Medicine,1998516-25.??
31
???(?????Diflucan)???(???????)
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• 7?????????7??????100mg
• PT??????(???????)
• ?????

70 60 50 40 30 20 10
0
1 2 3 4 5 6 7 ??
? ?
Crussell Porter LL et al. Arch Intern Med 1993
153 102-104.
32
???????????????(ACEI)?????????

• 5???(??ACEI,???8?18????????)?????????????
• ??5????50??????????,??4???????
• ???? 9.4?11mEq/L
• 2?????(????????????)

Chiu T-F et al. Ann Emerg Med 1997 30 612-615.
33
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