精神类药物临床合理用药及常见不良反应探究

Study on the rational use of psychotropic drugs and common adverse reactions

目的 分析常用精神药物说明书标注的信息,客观认识该类药品不良反应(ADR),为促进临床合理用药提供参考.方法 对收集到我市精神病专科医院及二级以上综合医院临床常用的92份国内外口服精神药物说明书进行分类、审阅,综合分析常见的各种ADR、特殊人群用药和药动学相关参数.结果 精神药物常见ADR累及器官或系统多且严重;孕妇、哺乳期、儿童和老年人用药中出现含糊的文字“遵医嘱或酌减或尚未确定或尚未研究”的描述较多;大部分精神药品有活性代谢物、药物半衰期(T1/2)长、血浆蛋白结合率高,有些药物[如选择性5-羟色胺再摄取抑制剂(SSRIs)]对P450有很强的抑制作用.结论 医师、药师、患者及家属应结合患者自身的机体状况和精神状态共同制定个体化的给药方案,谨慎联合用药,提高患者用药的依从性.

Objective To analyze the information marked in the instructions of commonly used psychotropic drugs and objectively understand the adverse drug reactions(ADR),so as to provide reference for promoting the rational clinical use of drugs.Methods A total of 92 commonly used instructions of oral psychotropic drugs at home and abroad collected from psychiatric specialty hospitals and over second-level general hospitals in our city were classified and reviewed,and various common ADR,medication and pharmacokinetic parameters of special population were analyzed synthetically.Results The ADR of common psychotropic drugs involved many organs or systems and was serious.There were many vague words like"following doctor′s advice or reducing or having not been determined or studied"in the medication of pregnant women,lactation,children and the elderly.Most psychotropic drugs had active metabolites,long drug half-life(T1/2)and high plasma protein binding rate,some drugs,such as selective serotonin reuptake inhibitors(SSRIs)had strong inhibition on P450.Conclusion Physicians,pharmacists,patients and their family members should work out individualized drug delivery plans in combination with the patients′own physical and mental conditions,carefully combine medications,and improve the compliance of patients with drugs.