基于治疗药物监测的氟伏沙明血药浓度结果及其影响因素分析

Research on the therapeutic drug monitoring and influence factors of fluvoxamine

目的分析氟伏沙明在治疗药物监测中的血药浓度结果,探究影响剂量校正后浓度的因素,为临床实施个体化用药提供参考。方法回顾性收集我院服用氟伏沙明的住院患者的治疗药物监测结果,分析剂量、性别、年龄、主要合并用药对稳态浓度与剂量校正后浓度的影响。结果患者服用氟伏沙明的平均日剂量为(203.57±85.85)mg·d^(-1),血药浓度均值为(187.00±188.89)ng·mL^(-1),剂量校正后浓度均值为(0.88±0.75)ng·mL^(-1)·mg^(-1)·d。日剂量25~300 mg·d^(-1),300~400 mg·d^(-1)组血药浓度分别为(176.35±170.83),(424.88±380.33)ng·mL^(-1),剂量校正后浓度分别为(0.87±0.74),(1.12±1.00)ng·mL^(-1)·mg^(-1)·d。男性、女性患者血药浓度分别为(182.89±199.99),(199.79±151.02)ng·mL^(-1),剂量校正后浓度分别为(0.80±0.71),(1.12±0.83)ng·mL^(-1)·mg^(-1)·d。小于40岁,大于40岁患者的血药浓度分别为(181.32±192.79),(211.86±172.01)ng·mL^(-1),剂量校正后浓度分别为(0.81±0.71),(1.18±0.88)ng·mL^(-1)·mg^(-1)·d。性别、年龄、合并氨磺必利对剂量校正后浓度有显著影响(P<0.05)。结论临床上使用氟伏沙明,女性、老年患者应低剂量给药,并密切监测血药浓度。患者服用氟伏沙明个体间差异大,影响因素复杂,临床医师或临床药师可利用治疗药物监测,结合临床疗效,指导临床调整用药。

Objective Research on the therapeutic drug monitoring,the influence factors of serum concentrations and dosage-related concentrations of fluvoxamine in patients were investigated.Methods The results of therapeutic drug monitoring in psychiatric patients treated with fluvoxamine were reviewed from January 1^(st),2018 to January 31^(st),2021.Effects of dosage,gender,age,concomitant medication on serum concentrations and dosage-related concentrations were evaluated,and then analyzed by SPSS 25.0 software retrospectively.Results The mean daily dose of fluvoxamine for patients was(203.57±85.85)mg·d^(-1).The mean serum concentration of fluvoxamine was(187.00±188.89)ng·mL^(-1),and the mean dosage-related concentration was(0.88±0.75)ng·mL^(-1)·mg^(-1)·d.The serum concentration in daily dose of 25-300 mg·d^(-1) and 300-400 mg·d^(-1) groups were(176.35±170.83)and(424.88±380.33)ng·mL^(-1),the mean dosage-related concentrations were(0.87±0.74)and (1.12±1.00)ng·mL^(-1)·mg^(-1)·d.The mean serum concentration in male and female were(182.89±199.99),(199.79±151.02)ng·mL^(-1),the mean dosage-related concentrations were(0.80±0.71),(1.12±0.83)ng·mL^(-1)·mg^(-1)·d.Patients younger than 40 years old and older than 40 years old were(181.32±192.79)and(211.86±172.01)ng·mL^(-1),the mean dosage-related concentration were(0.81±0.71)and(1.18±0.88)ng·mL^(-1)·mg^(-1)·d.Gender,age,combined with amisulpride had significant impact on dosage-related concentrations(all P<0.05).Conclusion In clinical,the dosage of fluvoxamine for female and elderly may be reduced.The influential factors of serum concentrations for fluvoxamine are complicated,and showed a significant individual difference.Doctors or clinical pharmacists should use therapeutic drug monitoring,combined with clinical efficacy,to guide clinical adjustment of medication.