新型抗抑郁药和第二代抗精神病药的相互影响

发布时间：2018-01-19 14:28

本文关键词： 新型抗抑郁药物第二代抗精神病药物药代动力学药效动力学相互影响　出处：《重庆医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：新型抗抑郁药物和第二代抗精神病药物(the second-generation antipsychotics, SGAs)临床上常联合使用。新型抗抑郁药物和SGAs常被同时用于即存在精神病性症状又存在抑郁症状的患者,如分裂样情感障碍和精神病性抑郁症；新型抗抑郁药用于辅助改善精神分裂症阴性症状；SGAs辅助用于伴有明显强迫症状的抑郁症患者和难治性抑郁症。这两类药通常都经肝细胞色素P450(the hepatic cytochrome P450, CYP)系统途径代谢,许多新型抗抑郁药物具有CYP酶抑制作用,减少了经该途径代谢的抗精神病药物的消除,引起药代动力学的相互影响。比如,氟西汀使氯氮平、利培酮、阿立哌唑的血药浓度都有不同程度升高,氟伏沙明使主要经CYP1A2酶代谢的氯氮平、奥氮平的血药浓度明显升高。联合用药可能取得更好的效果,但风险亦加大,临床应当尤其重视致命性的不良反应,如QTc间期延长引起的尖端扭转型室速。
[Abstract]:A new antidepressant and a second generation antipsychotic, the second-generation antipsychotics. New antidepressants and SGAs are often used in patients with both psychotic and depressive symptoms, such as split-like affective disorder and psychotic depression. New antidepressants are used to improve the negative symptoms of schizophrenia. SGAs adjuncts are used in patients with depression and refractory depression with obvious obsessive-compulsive symptoms. Both types of drugs are commonly transduced by hepatocytochrome P450. The hepatic cytochrome P450. CYP- systematic pathway metabolism, many new antidepressants have CYP enzyme inhibition, reducing the elimination of antipsychotic drugs metabolized by this pathway, causing pharmacokinetic interaction. For example. Fluoxetine increased serum concentrations of clozapine, risperidone, and aripiprazole to varying degrees, and florvoxamine caused clozapine, which was mainly metabolized by CYP1A2 enzymes. The serum concentration of olanzapine is significantly increased. Combination therapy may achieve better results, but the risk is also increased. Clinical attention should be paid to the fatal adverse reactions, such as the tip torsional ventricular tachycardia caused by the prolongation of QTc interval.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R749

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