妊娠期妇女新型抗癫痫药的药物浓度监测研究进展

发布时间：2018-05-09 12:31

本文选题：拉莫三嗪 + 左乙拉西坦　；参考：《中国药房》2017年08期

【摘要】：目的:了解妊娠期妇女新型抗癫痫药拉莫三嗪(LTG)、左乙拉西坦(LEV)、托吡酯(TPM)和奥卡西平(OXC)的药物浓度监测的研究进展。方法:查阅近年来国内外相关文献,就LTG、LEV、TPM和OXC的药物浓度监测的研究进行归纳和总结。结果与结论:LTG、LEV、TPM和OXC在妊娠期的代谢率增加,血药浓度显著下降,部分患者癫痫发作频率增加,产后血药浓度迅速恢复至正常水平,但上述4种药物的具体变化情况存在差异,且个体差异显著。LTG、LEV、TPM和OXC在妊娠期血药浓度的下降可能与葡糖醛酸化作用增强和肾清除率增加相关,但显著的个体差异导致不能提前预测和预防。妊娠期血药浓度的下降不等于癫痫发作频率的增加,规律的药物浓度监测给剂量调整提供了证据支持。虽然仍缺乏LTG、LEV、TPM和OXC大范围适用的妊娠期有效的血药浓度推荐范围,仍建议在妊娠前获得癫痫患者血药浓度基线水平作为参考,确定个体化的有效血药浓度范围,妊娠各阶段至少各进行1次治疗药物的浓度监测,若癫痫发作增加则应及时测定血药浓度并调整剂量;产后1~2周进行治疗药物的浓度监测,逐渐减量恢复至基线水平。
[Abstract]:Objective: to investigate the recent progress in monitoring the concentration of new antiepileptic drugs: lamotriazine LTGG, levoethetanolacetam, topiramate (TPMM) and oxacillin (OXC) in pregnant women. Methods: to review the domestic and foreign literatures in recent years and summarize the research on the drug concentration monitoring of LTG Lev TPM and OXC. Results and conclusion the metabolic rate of TPM and OXC in pregnancy increased, the serum drug concentration decreased significantly, the frequency of epileptic seizures increased, and the postpartum blood drug concentration quickly returned to normal level, but the specific changes of the above four drugs were different. The decrease of serum drug concentration in pregnancy may be related to the increase of glucuronide and the increase of renal clearance, but the significant individual difference can not be predicted and prevented in advance. The decrease of serum drug concentration during pregnancy does not mean the increase of epileptic seizure frequency. Regular monitoring of drug concentration provides evidence for dose adjustment. Although there is still a lack of a wide range of effective serum drug concentrations recommended for pregnancy, it is recommended that baseline levels of serum drug concentrations in epileptic patients be obtained before pregnancy as a reference to determine the range of individual effective serum drug concentrations. The concentration of treatment drugs should be monitored at least once in each stage of pregnancy, and the blood concentration should be measured in time and the dosage adjusted if epileptic seizures increased, and the concentration of treatment drugs should be monitored at 1 ~ 2 weeks postpartum, gradually reducing back to the baseline level.
【作者单位】：中国药科大学基础医学与临床药学学院;四川省人民医院药学部;
【分类号】：R969.3

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