常用药物配伍禁忌表

常用药物配伍禁忌表 来源: 王中南的日志 当应用一种药物疗效不佳时，就需要选择其他的药物进行合理的配伍。但是并不是所有 的配伍都是合理的，有些配伍使药物的治疗作用减弱，导致治疗失败;有些配伍使副作用 或毒性增强，引起严重不良反应;还有些配伍使治疗作用过度增强，超出了机体所能耐受 的能力，也可引起不良反应，乃至危害病人等。这些配伍均属配伍禁忌。 临床上常见的配伍禁忌 1.β-内酰胺类药物与丙磺舒合用，可使前者在肾小管的分泌减少、血药浓度增加、作 用时间延长。因此，二者合用时，应注意减少前者的用药剂量。 2.β-内酰胺类药物不可与酸性或碱性药物配伍。如:氨基糖苷类、氨基酸、红霉素类 、林可霉素类、维生素C、碳酸氢钠、氨茶碱、谷氨酸钠等。因此，输液时只能用生理盐水 溶解药物，不能用葡萄糖注射液溶解。 3.氟氯西林勿与血液、血浆、水解蛋白及脂肪乳配伍。其他β-内酰胺类药物也应注意 。 4.头孢菌素类(特别是第一代头孢菌素)不可与高效利尿药(如速尿)联合应用，防 止发生严重的肾损害。青霉素类中的美西林也不可与其配伍。 5.头孢西丁钠与多数头孢菌素均有拮抗作用，配伍应用可致抗菌疗效减弱。与氨曲南 配伍，在体内外均起拮抗作用，与萘夫西林、氯唑西林、红霉素、万古霉素等，在药效方 面不起相互干扰作用。 6.氨基糖苷类药物不宜与具有耳毒性(如红霉素等)和肾毒性(如强效利尿药、头孢 菌素类、右旋糖苷类、藻酸钠等)的药物配伍，也不宜与肌肉松弛药或具有此作用的药物 the public to participate in, in imperceptible provided L people's cultural quality. To built use "Juxian issued on the micro channel," civilized Juxian "micro channel, Ju, networks and other mainstream network media continued to push send online is energy information, and create a good network environment. Deepen the action of the beautiful countryside civilization, to carry out a wide range of" new countryside, new life "training, give full play to the village population culture courtyard, Park Street, cultural square and other positions the role of publicity and education, promote rural way of life more civilized. This year the province's urban and rural sanitation integration of the rural masses satisfaction telephone survey, significantly improved performance in our county, respectively, than the end of last year, years to improve the 5.2,17.5 percentage points. The township streets. Relevant departments of counties units should conscientiously sum up experience, adhere to the problem oriented, people are not satisfied with the village as the focus of the work, insist on grasping both ends, with the middle, to consolidate and improve, expand further effort, in the realization of the normal long-term efforts, to ensure that the end of this year to obtain better results. Third, we need to accelerate the voluntary service system. To actively promote the party members and members and cadres normalization of volunteer service, do a good job in public places, window units and community volunteer service station construction, establishment of covering the whole (如地西泮等)配伍，防止毒性加强。本类药物之间也不可相互配伍。 7.大环内酯类药物可抑制茶碱的正常代谢。两者联合应用，可致茶碱血浓度的异常升 高而致中毒，甚至死亡，因此联合应用时应进行监测茶碱的血浓度，以防意外。此外，本 类药物对酸不稳定，因此，在5%-10%葡萄糖输液500ml中，添加维生素C注射液(含抗坏血 酸钠1g)或5%碳酸氢钠注射液0.5ml使pH升高到6左右，再加红霉素乳糖酸盐，则有助稳定 。另外，β-内酰胺类药物与本类药物配伍，可发生降效作用;与口服避孕药合用，也可使 之降效(因本类药物可阻挠性激素类的肠肝循环)。克拉霉素可使地高辛、茶碱、口服抗 凝血药、麦角胺或二氢麦角胺、三唑仑均显示更强的作用，对卡马西平、环胞霉素、己巴 比妥、苯妥英钠等也可有类似的阻滞代谢而使作用加强。本类药物与β-内酰胺类药物配伍 ，一般认为可发生降效作用。此外，氟喹诺酮类也可抑制茶碱的代谢。 8.去甲万古霉素与许多药物可产生沉淀反应，因此含本品的输液中不得添加其他药物 。克林霉素不宜加入组成复杂的输液中，以免发生配伍禁忌;此外，本类药物与红霉素有 拮抗作用，不可联合应用。磷霉素与一些金属盐可生成不溶性沉淀，勿与钙、镁等盐相配 伍。 9.抑制肠道菌群的药物可抑制柳氮磺吡啶在肠道中的分解，从而影响5-氨基水杨酸的 游离，有降效的可能，尤以各种广谱抗菌药物为甚。 10.呋喃妥因与萘啶酸有拮抗作用，不宜合用。呋喃唑酮有单胺氧化酶抑制作用，可抑 制苯丙胺等药物的代谢而导致血压升高;使用本品期间，食用含多量酪胺的食物，也可有 类似反应。 11.碱性药物、抗胆碱药物、H2受体阻滞剂均可降低胃液酸度而使喹诺酮类药物的吸收 减少，应避免同服。利福平(RNA合成抑制药)、氯霉素(蛋白质合成抑制药)均可使本类 the public to participate in, in imperceptible provided L people's cultural quality. To built use "Juxian issued on the micro channel," civilized Juxian "micro channel, Ju, networks and other mainstream network media continued to push send online is energy information, and create a good network environment. Deepen the action of the beautiful countryside civilization, to carry out a wide range of" new countryside, new life "training, give full play to the village population culture courtyard, Park Street, cultural square and other positions the role of publicity and education, promote rural way of life more civilized. This year the province's urban and rural sanitation integration of the rural masses satisfaction telephone survey, significantly improved performance in our county, respectively, than the end of last year, years to improve the 5.2,17.5 percentage points. The township streets. Relevant departments of counties units should conscientiously sum up experience, adhere to the problem oriented, people are not satisfied with the village as the focus of the work, insist on grasping both ends, with the middle, to consolidate and improve, expand further effort, in the realization of the normal long-term efforts, to ensure that the end of this year to obtain better results. Third, we need to accelerate the voluntary service system. To actively promote the party members and members and cadres normalization of volunteer service, do a good job in public places, window units and community volunteer service station construction, establishment of covering the whole 药物的作用降低，使萘啶酸和氟哌酸的作用完全消失，使氟嗪酸和环丙氟哌酸的作用部分 抵消。 12.克林霉素与红霉素有拮抗作用，不可联合应用，也不宜组成复杂的输液。 13.四环素类避免与抗酸药、钙盐、铁盐及其他含重金属离子的药物配伍，以防发生络 合反应，阻滞四环素类的吸收。牛奶也有类似的作用。 14.磺胺类不宜与含对氨苯甲酰基的局麻药(如:普鲁卡因、苯佐卡因、丁卡因等)合 用，以免降效。 15.多粘菌素B与其他有肾毒性或神经肌肉阻滞作用的药物不可配伍，以防意外。 16.对氨基水杨酸钠忌与水杨酸类同服，以免胃肠道反应加重及导致胃溃疡。此外，本 品可干扰利福平的吸收，同时应用应间隔6-8小时。 17.酮康唑和异曲康唑的吸收和胃液的分泌密切相关，因此不宜与抗酸药、抗胆碱药 18.多沙普仑禁与碱性药合用;慎与拟交感胺、单胺氧化酶抑制剂(MAOI)合用。 19.吗啡禁与氯丙嗪注射液合用。哌替啶不宜与异丙嗪多次合用，以免发生呼吸抑制; 与单胺氧化酶抑制剂(MAOI)合用可引起兴奋、高热、出汗、神志不清。芬太尼也有此反 应。 20.阿司匹林与糖皮质激素合用可能是胃肠道出血加剧，应禁止配伍;与布洛芬等非甾 体抗炎药合用使后者的浓度明显降低，也不宜合用;与碱性药配伍，可促进本品的排泄而 降低疗效，不宜合用。 the public to participate in, in imperceptible provided L people's cultural quality. To built use "Juxian issued on the micro channel," civilized Juxian "micro channel, Ju, networks and other mainstream network media continued to push send online is energy information, and create a good network environment. Deepen the action of the beautiful countryside civilization, to carry out a wide range of" new countryside, new life "training, give full play to the village population culture courtyard, Park Street, cultural square and other positions the role of publicity and education, promote rural way of life more civilized. This year the province's urban and rural sanitation integration of the rural masses satisfaction telephone survey, significantly improved performance in our county, respectively, than the end of last year, years to improve the 5.2,17.5 percentage points. The township streets. Relevant departments of counties units should conscientiously sum up experience, adhere to the problem oriented, people are not satisfied with the village as the focus of the work, insist on grasping both ends, with the middle, to consolidate and improve, expand further effort, in the realization of the normal long-term efforts, to ensure that the end of this year to obtain better results. Third, we need to accelerate the voluntary service system. To actively promote the party members and members and cadres normalization of volunteer service, do a good job in public places, window units and community volunteer service station construction, establishment of covering the whole 21.抗抑郁药不宜与MAOI合用。因二者作用相似，均有抗抑郁作用，合用时必须减量应 用。另外，也不宜与拟肾上腺素类药物合用。抗抑郁药可增强拟肾上腺素药的升压作用。 22.曲马朵忌与单胺氧化酶抑制剂合用。因二者作用相悖，相互抵消。 23.左旋多巴禁与单胺氧化酶抑制剂、麻黄碱、利血平及拟肾上腺素药合用。卡比多巴 不宜和金刚烷胺、苯扎托品、丙环定及苯海索合用。 24.溴隐亭忌与降压药、吩噻嗪类或H2受体阻滞剂合用。 25.卡马西平与苯巴比妥、苯妥英钠合用时，可加速卡马西平的代谢，使其浓度降低; 而烟酰胺、抗抑郁药、大环内酯类抗生素、异烟肼、西咪替丁等药均可使卡马西平的血药 浓度升高，使之易出现毒性反应。此外，抗躁狂药锂盐、抗精神病药硫利达嗪与卡马西平 合用时，易致本品出现神经系统中毒症状。卡马西平也可减弱抗凝血药华法林的抗凝作用 。而与口服避孕药合用时，可发生阴道大出血及避孕失败。故合用时应特别注意。 26.丙戊酸钠可抑制苯妥英钠、苯巴比妥、扑米酮、氯硝西泮的代谢，易使其中毒，故 在合用时应注意调整剂量。 27.苯巴比妥为肝药酶诱导剂，因此可使双香豆素、氢化可的松、地塞米松、睾丸酮、 雌激素、孕激素、口服避孕药、氯丙嗪、氯霉素、多西环素、灰黄霉素、地高辛、洋地黄 毒甙及苯妥英钠等药合用时代谢加速疗效降低;也可使在体内活化的药物作用增加，如环 磷酰胺等。其他的肝药酶诱导剂(如:别嘌呤醇、乙胺碘呋酮、氯霉素、氯丙嗪、西咪替 丁、环丙沙星、右丙氧芬、地尔硫卓、乙醇(急性中毒时)、红霉素、丙米嗪、异烟肼、 酮康唑、美托洛尔、甲硝唑、咪康唑、去甲替林、口服避孕药、羟保泰松、奋乃静、保泰 松、伯氨喹、普萘洛尔、奎尼丁、丙戊酸钠、磺吡酮、磺胺药、硫利达嗪、甲氧苄啶、维 the public to participate in, in imperceptible provided L people's cultural quality. To built use "Juxian issued on the micro channel," civilized Juxian "micro channel, Ju, networks and other mainstream network media continued to push send online is energy information, and create a good network environment. Deepen the action of the beautiful countryside civilization, to carry out a wide range of" new countryside, new life "training, give full play to the village population culture courtyard, Park Street, cultural square and other positions the role of publicity and education, promote rural way of life more civilized. This year the province's urban and rural sanitation integration of the rural masses satisfaction telephone survey, significantly improved performance in our county, respectively, than the end of last year, years to improve the 5.2,17.5 percentage points. The township streets. Relevant departments of counties units should conscientiously sum up experience, adhere to the problem oriented, people are not satisfied with the village as the focus of the work, insist on grasping both ends, with the middle, to consolidate and improve, expand further effort, in the realization of the normal long-term efforts, to ensure that the end of this year to obtain better results. Third, we need to accelerate the voluntary service system. To actively promote the party members and members and cadres normalization of volunteer service, do a good job in public places, window units and community volunteer service station construction, establishment of covering the whole 拉帕米等)也有此反应。而肝药酶抑制剂(如:巴比妥类(苯巴比妥为最)、卡马西平、 乙醇(慢性酒精中毒者)、氨鲁米特、灰黄霉素、氨甲丙酯、苯妥英、格鲁米特、利福平 、磺吡酮(某些情况下起酶抑作用)、奥美拉唑、兰索拉唑等)恰好相反。 28.普萘洛尔不宜与单胺氧化酶抑制剂合用。否则，作用减弱。 29.噻吗洛尔滴眼时可被吸收而产生全身作用，故不宜与其他β受体阻滞剂合用。 30.维拉帕米不宜与β受体阻滞剂合用，否则，会产生低血压、心动过缓、传导阻滞， 甚至停搏。 31.在应用强心甙期间，忌用钙注射液、肾上腺素、麻黄碱及其类似药物。因这些药物 可增加其毒性。此外，利血平可增加其对心脏的毒性，也应警惕。由于这类药物脂溶性高 ，主要在肝脏代谢，故在和肝酶诱导剂或抑制剂合用时，应注意调整剂量。 32.像去甲肾上腺素这类以强碱弱酸盐形式应用的药物，避免和碱性药物配伍，否则， 会产生沉淀。 33.乙酰半胱氨酸能增加金制剂的排泄;减弱青霉素、四环素、头孢菌素类的抗菌活性 ，故不宜合用。必要时可间隔4小时交替使用。 34.可待因类中枢镇痛药与中枢抑制药合用，可产生相加作用。 35.右美沙芬与单胺氧化酶抑制剂合用，可致高烧、昏迷，甚至死亡。 36.麻黄碱与单胺氧化酶抑制剂合用，可引起血压过高。 37.酮替芬与口服降糖药合用，少数患者可见血小板减少，故二者不宜合用。 38.西咪替丁不宜与抗酸剂、甲氧氯普胺合用，如必须合用，应间隔1小时。此外，也 the public to participate in, in imperceptible provided L people's cultural quality. To built use "Juxian issued on the micro channel," civilized Juxian "micro channel, Ju, networks and other mainstream network media continued to push send online is energy information, and create a good network environment. Deepen the action of the beautiful countryside civilization, to carry out a wide range of" new countryside, new life "training, give full play to the village population culture courtyard, Park Street, cultural square and other positions the role of publicity and education, promote rural way of life more civilized. This year the province's urban and rural sanitation integration of the rural masses satisfaction telephone survey, significantly improved performance in our county, respectively, than the end of last year, years to improve the 5.2,17.5 percentage points. The township streets. Relevant departments of counties units should conscientiously sum up experience, adhere to the problem oriented, people are not satisfied with the village as the focus of the work, insist on grasping both ends, with the middle, to consolidate and improve, expand further effort, in the realization of the normal long-term efforts, to ensure that the end of this year to obtain better results. Third, we need to accelerate the voluntary service system. To actively promote the party members and members and cadres normalization of volunteer service, do a good job in public places, window units and community volunteer service station construction, establishment of covering the whole 不宜与茶碱、苯二氮卓类安定药、地高辛、奎尼丁、咖啡因、华法林类抗凝药、卡托普利 及氨基糖苷类药物配伍。 39.酶类助消化药不宜与抗酸剂合用，否则，使其活性降低。 40.胃动力药(多潘立酮、西沙必利)不宜与抗胆碱药合用，作用相互抵消。 41.思密达可影响其他药物的吸收，如必须合用时，应在服用本品前1小时服用其他药 物。 42.铁剂不宜与含钙、磷酸盐类、鞣酸的药物及抗酸剂和浓茶合用，否则，可形成沉淀 ，影响其吸收;与四环素类合用，可相互影响吸收. the public to participate in, in imperceptible provided L people's cultural quality. To built use "Juxian issued on the micro channel," civilized Juxian "micro channel, Ju, networks and other mainstream network media continued to push send online is energy information, and create a good network environment. Deepen the action of the beautiful countryside civilization, to carry out a wide range of" new countryside, new life "training, give full play to the village population culture courtyard, Park Street, cultural square and other positions the role of publicity and education, promote rural way of life more civilized. This year the province's urban and rural sanitation integration of the rural masses satisfaction telephone survey, significantly improved performance in our county, respectively, than the end of last year, years to improve the 5.2,17.5 percentage points. The township streets. Relevant departments of counties units should conscientiously sum up experience, adhere to the problem oriented, people are not satisfied with the village as the focus of the work, insist on grasping both ends, with the middle, to consolidate and improve, expand further effort, in the realization of the normal long-term efforts, to ensure that the end of this year to obtain better results. Third, we need to accelerate the voluntary service system. To actively promote the party members and members and cadres normalization of volunteer service, do a good job in public places, window units and community volunteer service station construction, establishment of covering the whole