奥氮平血药浓度/剂量比影响因素分析及其治疗药物监测的临床应用Influencing Factors of Olanzapine Blood Concentration/Dose Ratio and its Clinical Application of Therapeutic Drug Monitoring
张明;陈宏镇;卢浩扬;陈雨晴;谢焕山;于东港;王占璋;尚德为;温预关;
摘要(Abstract):
目的:探讨性别、年龄、给药剂量及联合用药对服用奥氮平患者稳态血药浓度的影响,为临床合理用药提供参考。方法:收集2018年2—7月广州医科大学附属脑科医院服用奥氮平患者的性别、年龄、给药剂量、联合用药及血药浓度等基本信息,采用SPSS 16.0统计学软件对数据进行统计分析。结果:在多重线性回归方程中,性别、年龄、给药剂量及联合用药仅能解释26.6%的奥氮平血药浓度变化。女性患者奥氮平浓度剂量比(C/D)高于男性患者;年龄对稳态血药浓度的影响较弱;联合应用丙戊酸钠能明显降低奥氮平血药浓度,氯氮平对奥氮平血药浓度的影响有待进一步研究。结论:奥氮平具有较大的个体间药动学差异,且血药浓度影响因素复杂,推荐进行常规的治疗药物监测,医师应结合血药浓度及临床疗效调整、优化给药方案。
关键词(KeyWords): 奥氮平;治疗药物监测;血药浓度;合理用药
基金项目(Foundation): 广东省自然科学基金资助项目(No.2015A030313808);; 广州市卫生和计划生育科技一般引导项目(No.2016A010045)
作者(Authors): 张明;陈宏镇;卢浩扬;陈雨晴;谢焕山;于东港;王占璋;尚德为;温预关;
DOI: 10.14009/j.issn.1672-2124.2019.07.009
参考文献(References):
- [1] Hasan A,Falkai P,Wobrock T,et al.World Federation of Societies of Biological Psychiatry(WFSBP)guidelines for biological treatment of schizophrenia,part 1:update 2012 on the acute treatment of schizophrenia and the management of treatment resistance[J].World J Biol Psychiatry,2012,13(5):318-378.
- [2] Kantrowitz JT,Citrome L.Olanzapine:review of safety 2008[J].Expert Opin Drug Saf,2008,7(6):761-769.
- [3] Lieberman JA,Stroup TS,McEvoy JP,et al.Effectiveness of antipsychotic drugs in patients with chronic schizophrenia[J].N Engl J Med,2005,353(12):1209-1223.
- [4] 蔡美香,陈晓明,刘惠萍.小剂量阿立哌唑或奥氮平辅治难治性抑郁症的临床疗效比较[J].临床合理用药杂志,2018,11(35):54-55.
- [5] 孙改红,徐富国.二甲双胍干预奥氮平所致精神分裂症患者糖脂代谢异常和体质量增加的效果观察[J].中国医院用药评价与分析,2017,17(4):489-491.
- [6] Hiemke C,Bergemann N,Clement HW,et al.Consensus Guidelines for Therapeutic Drug Monitoring in Neuropsychopharmacology:Update 2017[J].Pharmacopsychiatry,2018,51(1-02):9-62.
- [7] 陈雨晴,黄文灿,倪晓佳,等.LC-MS/MS法测定人血清中奥氮平的不确定度评价[J].中国医院药学杂志,2018,38(12):1261-1265.
- [8] 倪晓佳,王占璋,卢浩扬,等.HPLC-MS/MS法同时测定人血清中利培酮与帕利哌酮及奥氮平和喹硫平的浓度[J].中国临床药理学杂志,2018,34(1):53-56.
- [9] 汪春运.吸烟降低精神药物浓度[J].临床荟萃,2010,25(6):540-543.
- [10] Wu TH,Chiu CC,Shen WW,et al.Pharmacokinetics of olanzapine in Chinese male schizophrenic patients with various smoking beh-aviors[J].Prog Neuropsychopharmacol Biol Psychiatry,2008,32(8):1889-1893.
- [11] Bergemann N,Frick A,Parzer P,et al.Olanzapine plasma concen-tration,average daily dose,and interaction with co-medication in schizophrenic patients[J].Pharmacopsychiatry,2004,37(2):63-68.
- [12] 刘宝贵,王龙,杜远.丙戊酸盐联合奥氮平对双相障碍躁狂发作患者的临床效果分析[J].中南医学科学杂志,2018,46(6):625-628.
- [13] 朱桂东,宋清海,徐伟杰,等.齐拉西酮联合奥氮平对老年难治性精神分裂症患者症状及血清瘦素和脑源性神经营养因子水平的影响[J].中国慢性病预防与控制,2019,27(3):219-222.
- [14] Vella T,Mifsud J.Interactions between valproic acid and quetiapine/olanzapine in the treatment of bipolar disorder and the role of thera-peutic drug monitoring[J].J Pharm Pharmacol,2017,66(6):747-759.