联合用药对阿立哌唑及其代谢物血药浓度的影响

Effect of Drug Combination on Blood Concentration of Aripiprazole and Its Metabolite

目的:考察联合用药对阿立哌唑(ARI)及其代谢物脱氢阿立哌唑(DARI)血药浓度的影响。方法:采集我中心2010年1月-2011年3月血药浓度临床检测数据库中服用ARI(包括联合用药)治疗的住院患者信息,入组231例,单独服用ARI者79例作为对照组,合并用药者152例。对13种精神科常用药对ARI及其代谢物血药浓度的影响进行分析。血药浓度测定采用高效液相色谱法,数据统计分析利用SPSS 13.0软件进行。结果:ARI合用丙戊酸钠、利培酮等治疗时,相比于对照组其剂量调节血药浓度(Concentration to dose ratios,C∶D比率,nmol·L-1·mg-1)分别降低了约17.6%(P=0.36)、24.2%(P=0.19),但组间比较差异无统计学意义;合用喹硫平,其C∶D比率降低了约30.1%,组间比较差异有统计学意义;合用文拉法辛、氯氮平等对ARI及DARI的血药浓度无显著性影响。结论:联合用药对ARI血药浓度有不同程度的影响,而对DARI浓度则无明显影响。在临床用药中,应考虑药物间的相互作用,适当调整剂量,以达到有效治疗结果。

OBJECTIVE： To investigate the effect of drug combination on blood concentration of aripiprazole （ARI） and its metabolite dehydroaripiprazole （DARI）. METHODS： The information of 231 inpatients receiving ARI （including drug combination） was collected from blood concentration clinical monitoring database of our center from Jan. 2010 to Mar. 2011. 152 inpatients received drug combination, and the remaining 79 was given ARI alone（control group）. The effects of 13 kinds of common antipsychotics drugs on ARI and its metabolite were analyzed. Blood concentrations of them were determined by HPLC, and data analysis was conducted by SPSS 13.0 software. RESULTS： Compared with control group, blood concentration of ARI （concentration to dose ratios, ratio of C to D, nmol·L^-1·mg^-1） in ARI combined with valproate group and risperidone group decreased by 17.6% （P=0.36） and 24.2% （P=0.19） approximately, there was no statistical significance. Ratio of C to D in ARI combined with quetiapine decreased by 30.1%, there was statistical significance. ARI combined with venlafaxine and clozapine had no significant effect on the blood concentration of ARI and DARI. CONCLUSION： Drug combination affects the blood concentration of ARI at different levels, but has no evident effect on the blood concentration of DARI. In the clinical practice, drug interactions should be considered and the dose should be adjusted to achieve an active result.