利福昔明

利福昔明(Rifaximin),商品名Xifaxan,是一种用于治疗旅行者腹泻肠躁症肝性脑病抗生素[3] 由于利福昔明的口服吸收率相当低,只有0.4%会吸收到血流中[4],因此可以在肠道达到相当高的药物浓度。

Rifaximin
临床资料
商品名英语Drug nomenclatureXifaxan, Zaxine, Xifaxanta, Normix, others[1]
AHFS/Drugs.comMonograph
MedlinePlusa604027
怀孕分级
给药途径口服
ATC码
法律规范状态
法律规范
药物动力学数据
生物利用度< 0.4%
药物代谢肝脏
生物半衰期6小时
排泄途径粪便(97%)
识别信息
  • (2S,16Z,18E,20S,21S,22R,23R,24R,25S,26S,27S,28E)-5,6,21,23,25-pentahydroxy-27-methoxy-2,4,11,16,20,22,24,26-octamethyl-2,7-(epoxypentadeca-[1,11,13]trienimino)benzofuro
    [4,5-e]pyrido[1,2-a]-benzimida-zole-1,15(2H)-dione,25-acetate
CAS号80621-81-4  checkY
PubChem CID
DrugBank
ChemSpider
UNII
KEGG
ChEBI
ChEMBL
CompTox Dashboard英语CompTox Chemicals Dashboard (EPA)
ECHA InfoCard100.111.624 编辑维基数据链接
化学信息
化学式C43H51N3O11
摩尔质量785.89 g·mol−1
3D模型(JSmol英语JSmol
熔点200至205 °C(392至401 °F) (分解)
  • CC(=O)O[C@H]3[C@H](C)[C@H](O)[C@H](C)[C@@H](O)[C@@H](C)\C=C\C=C(\C)C(=O)Nc6c2c(nc1cc(C)ccn12)c5c4C(=O)[C@@](C)(O/C=C/[C@H](OC)[C@H]3C)Oc4c(C)c(O)c5c6O
  • InChI=1S/C43H51N3O11/c1-19-14-16-46-28(18-19)44-32-29-30-37(50)25(7)40-31(29)41(52)43(9,57-40)55-17-15-27(54-10)22(4)39(56-26(8)47)24(6)36(49)23(5)35(48)20(2)12-11-13-21(3)42(53)45-33(34(32)46)38(30)51/h11-18,20,22-24,27,35-36,39,48-51H,1-10H3,(H,45,53)/b12-11+,17-15+,21-13-/t20-,22+,23+,24+,27-,35-,36+,39+,43-/m0/s1 checkY
  • Key:NZCRJKRKKOLAOJ-XRCRFVBUSA-N checkY

医疗用途

肠躁症

利福昔明在美国核准用于治疗肠躁症[5] 它具有抗发炎和抗菌效果,且难被肠道吸收入身体循环,因而能在肠道发挥局部作用,有效缓解非便秘型肠躁症 (IBS)的慢性功能症状。即使反复使用似乎仍能保持效果。 [6] [7] 利福昔明特别适用于怀疑肠躁症与小肠细菌过度生长有关的病人。

困难梭菌感染

利福昔明可能可以与万古霉素并用以治疗复发性困难梭菌感染[8] [9] 不过这些研究的证据等级不高。[10]

肝性脑病

虽然缺乏良好证据,但利福昔明似乎与其他现有的肝性脑病治疗方法(如乳果糖 )一样有效,耐受性更好,并且可能更快发生效果。 它可减少肠道中产生氨的细菌,而能减轻肝性脑病的症状,降低了死亡率[11] 利福昔明的缺点是比较昂贵,且目前对于肝性脑病患者,缺乏未并用乳果糖治疗的临床试验。

特别注意

对于Child-Pugh评分为C级严重程度的肝硬化患者 ,必须谨慎使用。 [11]

副作用

由于本药由肠胃道吸收程度不高,全身性副作用不多,副作用一般而言轻微并不常见 [6] 除非存在诸如免疫抑制和住院等危险因素,否则艰难梭菌感染通常不是由利福昔明疗法引起的。 利福昔明对艰难梭菌具有活性。

参考文献

  1. ^ Rifaximin international. Drugs.com. 2 November 2020 [11 November 2020]. (原始内容存档于2023-07-14). 
  2. ^ Xifaxan- rifaximin tablet. DailyMed. 1 October 2019 [11 November 2020]. (原始内容存档于2023-03-22). 
  3. ^ Rifaximin. The American Society of Health-System Pharmacists. [8 January 2017]. (原始内容存档于2020-03-01). 
  4. ^ Adachi, J. A., & DuPont, H. L. (2006). Rifaximin: a novel nonabsorbed rifamycin for gastrointestinal disorders. Clinical infectious diseases, 42(4), 541-547.
  5. ^ Rifaximin for the treatment of diarrhea-predominant irritable bowel syndrome. Expert Rev Gastroenterol Hepatol. 2016, 10 (4): 431–42. PMID 26753693. doi:10.1586/17474124.2016.1140571. 
  6. ^ 6.0 6.1 Rifaximin for the treatment of irritable bowel syndrome - a drug safety evaluation. Expert Opinion on Drug Safety. July 2016, 15 (7): 983–91. PMID 27149541. doi:10.1080/14740338.2016.1186639. 
  7. ^ Clinical Practice Guidelines for Irritable Bowel Syndrome in Korea, 2017 Revised Edition. Journal of Neurogastroenterology and Motility. April 2018, 24 (2): 197–215. PMC 5885719 . PMID 29605976. doi:10.5056/jnm17145. 
  8. ^ Interruption of recurrent Clostridium difficile-associated diarrhea episodes by serial therapy with vancomycin and rifaximin. Clinical Infectious Diseases. March 2007, 44 (6): 846–8. PMID 17304459. doi:10.1086/511870. 
  9. ^ A randomized, double-blind, placebo-controlled pilot study to assess the ability of rifaximin to prevent recurrent diarrhoea in patients with Clostridium difficile infection. The Journal of Antimicrobial Chemotherapy. December 2011, 66 (12): 2850–5. PMID 21948965. doi:10.1093/jac/dkr377. 
  10. ^ Antibiotic treatment for Clostridium difficile-associated diarrhoea in adults. The Cochrane Database of Systematic Reviews. March 2017, 3: CD004610. PMC 6464548 . PMID 28257555. doi:10.1002/14651858.CD004610.pub5. 
  11. ^ 11.0 11.1 Profile of rifaximin and its potential in the treatment of irritable bowel syndrome. Clin Exp Gastroenterol. 2015, 8: 159–67. PMC 4467648 . PMID 26089696. doi:10.2147/CEG.S67231.