不同丙戊酸盐和丙戊酸剂型对丙戊酸血药浓度的影响
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摘要
目的:研究不同丙戊酸盐和丙戊酸剂型对丙戊酸血药浓度的影响。方法:回顾性分析某院270例丙戊酸血药浓度监测报告,记录患者姓名、年龄、体质量、丙戊酸的用法与用量、联合用药情况(合用药品及其用法与用量)和血药浓度监测结果。分析不同丙戊酸盐和丙戊酸剂型对丙戊酸标准血药浓度的影响。结果:二元Logistic回归分析结果表明丙戊酸盐类型和剂型对标准血药浓度有显著影响(P<0.05);丙戊酸镁的标准血药浓度[(9.18±3.54)μg·kg·mL~(-1)·mg~(-1)]大于丙戊酸钠盐的标准血药浓度[(6.76±2.54)μg·kg·mL~(-1)·mg~(-1)];丙戊酸缓释片的标准血药浓度[(8.38±3.49)μg·kg·mL~(-1)·mg~(-1)]大于丙戊酸普通片的标准血药浓度[(6.88±2.54)μg·kg·mL~(-1)·mg~(-1)],差异均具有显著性(P<0.05)。结论:不同丙戊酸盐和丙戊酸剂型对丙戊酸血药浓度存在明显影响,如何选择丙戊酸盐和丙戊酸剂型对丙戊酸的合理运用具有重要意义。
OBJECTIVE To evaluate the effects of different valproate and valproic acid dosage forms on the plasma concentration of valproic acid.METHODS Totally 270 cases of valproic acid blood concentration monitoring reports in our hospital were retrospectively analyzed.All patient name,age,weight,usage and dosage of valproic acid,combined use of drugs(combined drug and usage and dosage)and blood concentration monitoring results were recorded.The effects of different valproate and valproic acid dosage forms on the standard blood concentration of valproic acid were analyzed.RESULTS The logistic regression analysis showed that valproate type and dosage form had significant effect on the standard blood concentration(P<0.05).The standard blood concentration of magnesium valproate(9.18±3.54μg·kg mL~(-1)·mg~(-1))was greater than that of valproate sodium(6.76±2.54μg·kg mL~(-1)·mg~(-1)).The standard blood concentration of the sustained release tablets of valproic acid(8.38±3.49μg·kg mL~(-1)·mg~(-1))was significantly higher than that of the standard valproic acid tablets(6.88±2.54μg·kg mL~(-1)·mg~(-1))(P<0.05).CONCLUSION Different valproate and valproic acid formulations have significant effects on valproic acid plasma concentration.The choice of valproate and valproic acid dosage forms has great importance to the rational use of valproic acid.
OBJECTIVE To evaluate the effects of different valproate and valproic acid dosage forms on the plasma concentration of valproic acid.METHODS Totally 270 cases of valproic acid blood concentration monitoring reports in our hospital were retrospectively analyzed.All patient name,age,weight,usage and dosage of valproic acid,combined use of drugs(combined drug and usage and dosage)and blood concentration monitoring results were recorded.The effects of different valproate and valproic acid dosage forms on the standard blood concentration of valproic acid were analyzed.RESULTS The logistic regression analysis showed that valproate type and dosage form had significant effect on the standard blood concentration(P<0.05).The standard blood concentration of magnesium valproate(9.18±3.54μg·kg mL~(-1)·mg~(-1))was greater than that of valproate sodium(6.76±2.54μg·kg mL~(-1)·mg~(-1)).The standard blood concentration of the sustained release tablets of valproic acid(8.38±3.49μg·kg mL~(-1)·mg~(-1))was significantly higher than that of the standard valproic acid tablets(6.88±2.54μg·kg mL~(-1)·mg~(-1))(P<0.05).CONCLUSION Different valproate and valproic acid formulations have significant effects on valproic acid plasma concentration.The choice of valproate and valproic acid dosage forms has great importance to the rational use of valproic acid.
引文
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[14]Marcus R,Khan A,Rollin L,et al.Efficacy of aripiprazoleadjunctive to lithium or valproate in the long-term treatmentof patients with bipolar I disorder with an inadequate responseto lithium or valproate monotherapy:a multicenter,doubleblind,randomized study[J].Bipolar Disord,2011,13(2):133-144.
[15]Yin XJ,Gao L,Li Y,et al.Comparative Evaluation of Small Dose of Magnesium Valproate and Therapeutic Dose of sodium Valproate in theTreatment of Epilepsy and Health Economics value[J].World Latest Med Inf(世界最新医学信息文摘),2017,17(7):25-26.
[16]Safar MM,Abdallah DM,Arafa NM,et al.Magnesium supplementation enhances the anticonvulsant potential of valproate in pentylenetetrazol-treated rats[J].Brain Res,2010,1334:58-64.
[17]He M,Dou HL,Zhou LJ,et al.Individualized Use Analysis of Valproate Based on Blood Concentration Monitoring in the Treatmentof 384 Cases of Epilepsy[J].China Pharmacit(中国药师),2018,21(5):864-866.
[18]Hu YP.Monitoring and analysis of serum concentrations of valproate sodium retard tablets in epilepsy patients of different ages[J].Chin Hosp Pharm J(中国医院药学杂志),2017,37(6):545-548.
[19]Zhang LJ,Wang R,Xie H,et al.DeterminationofMagnesium ValproteinPlasmabyHPLC-MS/MSMethodandItsPharmacokineticsinRats[J].Chin Pharma J(中国药学杂志),2011,46(5):378-381.
[20]Li Y,Li X,Shen CQ,et al.Pharmaceutical monitoring of serum concentration of valproic acid[J].Chin Hosp Pharm J(中国医院药学杂志),2018,38(3):302-304.
[21]Zhuang XX,Li J,Li M,et al.Serum concentration monitoring on valproic acid:an analysis of 144 cases of non standard/over standard[J].Evaluation and analysis of drug-use in hospitals of China(中国医院用药评价与分析),2018,18(6):844-846.
[22]LI Q,Wang S.Clinical Rational Application Analysis of Drug Formulation and Drug Delivery Route[J].Chin Hosp Pharm J(中国医院药学杂志),2011,31(18):1547-1548.
[23]Zhuang XX,Miao RH,Ni SD,et al.Research progress on therapeutic drug monitoring in clinical application of valproic acid[J].Drugs&Clinic(现代药物与临床),2018,33(11):3083-3086.
[2]Fisher RS,Cross JH,French JA,et al.Operational classification of seizure types by the International League Against Epilepsy:Position Paper of the ILAE Commission for Classification and Terminology[J].Epilepsia,2017,58:522-530.
[3]Xian YT,Human C,Wang G,et al.Prescribing patterns ofantidepressants,antipsychotics and mood stabilizers in bipolarpatients misdiagnosed with major depressive disorder inChina[J].Hum Psychopharmacol,2012,27(6):626-631.
[4]Geddes JR,Miklowitz DJ.Treatment of bipolar disorder[J].Lancet,2013,381(9878):1672-1682.
[5]Rosso G,Bertetto N,Coppola I,et al.Mood stabilizers in the treatment of bipolar disorder mixed states[J].Riv Psichiatr,2012,47(4):281-293.
[6]Hu XF,Zhang YJ,Wei LH,et al.Anaiysis the influenceing factors on plasma concentration of valproic acid sodium[J].Chin Hosp Pharm J(中国医院药学杂志),2017,37(13):1246-1249.
[7]Yang Y,Yan YD,Liu Y,et al.Discussion on the reference range of effective plasma concentration of seven drugs[J].Clin Med J(临床药物治疗杂志),2015,13(2):14-18.
[8]Li WB,Guo Wi,Ruan CJ,et al.AGNP Consensus Guidelines for Psychiatric Therapeutic Drug Monitoring:2011[J].Pract Pharm Clin Remedies(实用药物与临床),2016,19(10):1193-1217.
[9]Yu X,Fang YR.Guidelines for the prevention and treatment of bipolar disorder in China(2nd edition)[M].Beijing:Chinese Medical Multimedia Press,2015:37-39.
[10]Xie Y,Song MF,Zhang L,et al.Effect of CYP2C19 Genetic Polymorphism on Blood Concentration of Valproic Acid in Schizophrenia[J].Chin J Mod Appl Pharm(中国现代应用药学),2016,33(5):653-657.
[11]Liang FH,Meng DM,Xie H,et al.Effects of CYP2C19 gene polymorphism on plasma concentration of voriconazole in critically ill patients with invasive fungal infections[J].Chin Hosp Pharm J(中国医院药学杂志),2015,35(16):1456-1461.
[12]Chen Y.Comparison of efficacy of sodium valproate and magnesium valproate in the treatment of epilepsy[D].Chongqin:Chongqing Medical University,2013.
[13]Yin XJ,Gao L,Li Y,et al.Comparative Evaluation of Small Dose of Magnesium Valproate and Therapeutic Dose of sodium Valproate in theTreatment of Epilepsy and Health Economics value[J].World Latest Med Inf(世界最新医学信息文摘),2017,17(7):25-26.
[14]Marcus R,Khan A,Rollin L,et al.Efficacy of aripiprazoleadjunctive to lithium or valproate in the long-term treatmentof patients with bipolar I disorder with an inadequate responseto lithium or valproate monotherapy:a multicenter,doubleblind,randomized study[J].Bipolar Disord,2011,13(2):133-144.
[15]Yin XJ,Gao L,Li Y,et al.Comparative Evaluation of Small Dose of Magnesium Valproate and Therapeutic Dose of sodium Valproate in theTreatment of Epilepsy and Health Economics value[J].World Latest Med Inf(世界最新医学信息文摘),2017,17(7):25-26.
[16]Safar MM,Abdallah DM,Arafa NM,et al.Magnesium supplementation enhances the anticonvulsant potential of valproate in pentylenetetrazol-treated rats[J].Brain Res,2010,1334:58-64.
[17]He M,Dou HL,Zhou LJ,et al.Individualized Use Analysis of Valproate Based on Blood Concentration Monitoring in the Treatmentof 384 Cases of Epilepsy[J].China Pharmacit(中国药师),2018,21(5):864-866.
[18]Hu YP.Monitoring and analysis of serum concentrations of valproate sodium retard tablets in epilepsy patients of different ages[J].Chin Hosp Pharm J(中国医院药学杂志),2017,37(6):545-548.
[19]Zhang LJ,Wang R,Xie H,et al.DeterminationofMagnesium ValproteinPlasmabyHPLC-MS/MSMethodandItsPharmacokineticsinRats[J].Chin Pharma J(中国药学杂志),2011,46(5):378-381.
[20]Li Y,Li X,Shen CQ,et al.Pharmaceutical monitoring of serum concentration of valproic acid[J].Chin Hosp Pharm J(中国医院药学杂志),2018,38(3):302-304.
[21]Zhuang XX,Li J,Li M,et al.Serum concentration monitoring on valproic acid:an analysis of 144 cases of non standard/over standard[J].Evaluation and analysis of drug-use in hospitals of China(中国医院用药评价与分析),2018,18(6):844-846.
[22]LI Q,Wang S.Clinical Rational Application Analysis of Drug Formulation and Drug Delivery Route[J].Chin Hosp Pharm J(中国医院药学杂志),2011,31(18):1547-1548.
[23]Zhuang XX,Miao RH,Ni SD,et al.Research progress on therapeutic drug monitoring in clinical application of valproic acid[J].Drugs&Clinic(现代药物与临床),2018,33(11):3083-3086.