194例小儿抗癫痫药物血药浓度监测

目的:分析儿童抗癫痫药物的血药浓度监测结果,指导临床合理用药.方法:以荧光偏振免疫法(FPIA)对194例癫痫患儿进行血药浓度监测.结果:达到有效血药浓度112例(57.73%),低于有效血药浓度63例(32.47%),高于有效血药浓度19例(9.79%).结论:血药浓度监测对抗癫痫药(AED)治疗癫痫的个体化用药具有重要的临床意义.     

我院抗癫痫药血药浓度监测情况分析

目的:为临床合理应用抗癫痫药提供参考。方法:采用回顾性方法,对我院2007年499例抗癫痫药治疗患者服用苯妥英钠、苯巴比妥、卡马西平和丙戊酸钠的血药浓度结果进行统计、分析。结果:单一用药患者中,血药浓度在正常治疗范围内者206例/次,占61.49%。联合用药患者中,血药浓度在正常治疗范围内者仅45例/次,占44.12%;服用中药治疗的患者中检出含有以上4种药物者占59.68%,服用中药治疗的患者中血药浓度在正常治疗范围内者占3.23%。结论:在应用抗癫痫药时,通过监测血药浓度,能更好地控制治疗浓度,避免多药联用,实现个体化给药。中药中是否含有化学合成药物成分也应引起重视。     

卡马西平治疗儿童癫痫的血药浓度监测与合理用药

目的:研究儿童癫痫患者服用卡马西平后,其血药浓度、给药剂量及给药时间的关系。方法:对服用卡马西平及联合用其他抗癫痫药物的51例癫痫患儿,用荧光偏振免疫法(FPIA)监测其血药浓度,并结合疗效进行统计分析。结果:稳态血药浓度与给药剂量、给药时间、是否联合用药等有着密切的关系。结论:儿童癫痫患者服用卡马西平后的血药浓度个体差异大,及时监测血药浓度、调整给药剂量及给药时间,对控制儿童癫痫发作有重要意义。     

1 072例患者抗癫痫药血药浓度监测分析

［摘要］目的 通过对抗癫痫药物血药浓度监测结果分析,为临床提高本类药物的治疗水平作参考.方法 采用荧光偏振免疫法对568例服用丙戊酸钠、374例服用卡马西平、85例服用苯妥英钠和45例服用苯巴比妥的患者血药浓度监测结果及临床疗效分析、评价.结果 抗癫痫药治疗指数小,安全度较低,其作用的个体差异大.结论 癫痫患者应重视血药浓度监测,并结合其他因素调整用药方案,以达到安全、有效、合理应用抗癫痫药.     

我院2001～2006年抗癫痫药血药浓度监测数据分析

目的:阐述治疗药物监测(TDM)对抗癫痫药合理应用的意义,关注临床科室对TDM的认识程度。方法:建立抗癫痫药Access数据库,对我院2001～2006年抗癫痫药TDM结果进行分析。结果:我院抗癫痫药监测例数逐年上升;由监测结果计算的抗癫痫药有效浓度、高血药浓度、低血药浓度比例显示血药浓度监测极有必要,但患者的个体用药信息缺乏限制了抗癫痫药个体化用药的发展。结论:TDM虽应用日益广泛,但仍需医师、药师共同努力,以最大限度地保证抗癫痫药的个体化应用。     

对四种抗癫痫药物进行血药浓度监测的结果分析

目的通过对4种抗癫痫药物646例次血药浓度监测结果分析,为临床提高本类药物的治疗水平作参考。方法运用荧光偏振免疫法测定血药浓度,对我院4种抗癫痫药物血药浓度监测结果进行分析、评价。结果共监测646例次,达到有效治疗浓度者为57.43%;低于有效治疗浓度者为30.80%;高于有效治疗浓度者11.77%。结论抗癫痫药物血药浓度监测对癫痫患者合理用药有重要的指导作用,血药浓度个体差异较大,临床用药时需个体化给药。癫痫患者应重视血药浓度监测,并结合其他因素调整用药方案,以达到安全、有效、合理应用抗癫痫药。     

我院2009年抗癫痫药物血药浓度监测结果分析

目的:促进临床合理应用抗癫痫药物并提高其疗效。方法:回顾性分析我院2009年门诊或住院患者服用丙戊酸(VPA)、卡马西平(CBZ)、苯妥英钠(PHT)的487例癫痫患者的血药浓度监测结果。结果:487例监测中,248例(50.92%)在有效血药浓度范围内;177例(36.34%)低于有效血药浓度;51例(10.47%)高于有效血药浓度;11例(2.26%)未检出血药浓度。其中,在有效血药浓度范围内的3种药物比例分别是VPA(48.18%)、CBZ(74.29%)、PHT(10.87%)。结论:抗癫痫药物的血药浓度监测为临床设计个体化给药方案提供了依据,是保证安全、有效用药的重要措施。     

我院2003-2009年抗癫痫药血药浓度监测分析

目的:分析抗癫痫药血药浓度监测结果,评价治疗药物监测(TDM)对临床抗癫痫治疗的指导作用.方法:采用荧光偏振免疫法(FPIA)检测该院2003-2009年治疗605例疼痛患者服用抗癫痫药血药浓度.结果:除2009年外,该院抗癫痫药监测例数逐年上升,丙戊酸钠血药浓度在50-100ug/ml内的监测例/次最多占54.43%,卡马西平血药浓度在4-12ug/ml内的监测例/次最多占75.63%,苯妥英钠血药浓度相似文献   

118例癫痫患者卡马西平血药浓度监测结果及影响因素分析

目的 探讨癫痫患者卡马西平（CBZ）血药浓度的影响因素,为临床合理使用提供依据。方法 选取118例规律服用卡马西平治疗的癫痫患者作为研究对象,采用高效液相色谱法（HPLC）进行血药浓度监测,分析影响卡马西平血药浓度的因素。结果 75.42%的患者服用卡马西平后血药浓度控制在4~12 μg·mL^-1之间;性别因素、年龄因素对卡马西平血药浓度的影响不明显（P＞0.05）;联合其他抗癫痫药时,无效浓度比例较高,具有统计学差异(P＜0.05)。结论 服用卡马西平后,患者卡马西平血药浓度的个体差异大,尤其是合并使用其他癫痫药者。因此应避免联合使用,并积极监测患者药物浓度,实施个体化给药,促进安全合理使用。     

抗癫痫药物血药浓度检测的临床分析

目的通过对临床常用一线抗癫痫药物的血药浓度检测结果进行分析,为临床个体化给药治疗提供参考依据,确保用药安全。方法选择2011年1月至2012年12月新乡医学院第三附属医院药剂科收治的癫痫患者350例,根据患者的自愿原则分为卡马西平组（110例）、苯妥英钠组（90例）、苯巴比妥组（80例）和丙戊酸钠组（70例）。采用高效液相色谱法测定卡马西平、苯妥英钠、苯巴比妥、丙戊酸钠4种抗癫痫药物在各组患者体内的血药浓度,并对结果进行分析评价。结果不同年龄与血药浓度差异有统计学意义（P〈0．01）。结论对抗癫痫药物的血药浓度进行检测,有利于临床医师为患者设计个体化给药方案,保证用药安全,减少药物不良反应的发生。     

244例抗癫痫药血药浓度监测结果分析

目的：通过对抗癫痫药物血药浓度监测结果分析，为临床提高本类药物的治疗水平作参考。方法：采用荧光偏振免疫法对26例服用苯妥英钠、74例服用卡马西平、144例服用丙戊酸钠的患者血药浓度监测结果及临床疗效分析、评价。结果：本类药物治疗指数小，安全度较低，其作用的个体差异大。结论：癫痫患者应重视血药浓度监测，并结合其他因素调整用药方案。以达到安全、有效、合理应用本类药物。     

癫痫患者丙戊酸血药浓度监测及个体化给药

目的：为临床癫痫患者丙戊酸的合理用药提供参考。方法：采用荧光偏振免疫法对１２３ 例癫痫患者进行血药浓度监测,并对其结果及疗效进行分析总结。结果：达到丙戊酸有效血药浓度范围未有效控制的有１４ 例,占１１－４ ％ ;不在有效血药浓度范围而控制良好的有１１ 例,占８－９ ％ 。结论：丙戊酸的个体化给药必须综合考虑各方面的因素,不能仅仅以血药浓度为依据,并建议在适当情况下有必要监测游离丙戊酸血药浓度。     

丙戊酸钠血药浓度监测及意义

目的:为临床癫痫患者丙戊酸钠的合理用药提供参考.方法:采用荧光偏振免疫法对143例癫痫患者服用丙戊酸钠进行血药浓度监测,并对结果及疗效进行分析总结.结果:222例次监测结果在有效浓度范围内,占总例次的68.5%,而有6例次血药浓度在正常范围,未能控制癫痫症状,13例次出现毒性反应.血药浓度高于或低于正常浓度有102例次,占31.5%.结论:丙戊酸钠血药浓度监测对合理用药有重要的指导作用,血药浓度个体差异大,临床用药时需个体化给药.     

回顾性分析357例次小儿抗癫痫药物血药浓度

目的:回顾性分析4种常用抗癫痫药在儿童癫痫治疗中的血药浓度监测情况,以利指导合理用药。方法:采用HPLC法测定丙戊酸钠、卡马西平、苯巴比妥和苯妥英钠4种常用抗癫痫药物的血药浓度。结果:血药浓度在治疗窗内占47.1%,高于治疗窗占7.0%,低于治疗窗占45.9%。常规服药的患者有49.8%血药浓度在治疗窗内,联合用药致血药浓度偏离治疗窗达76.2%。结论:儿童使用抗癫痫药物监测血药浓度是指导临床用药的重要依据,特别是联合用药尤其应密切监测。     

Pharmacokinetics of diazepam in epileptic patients and normal volunteers following intravenous administration

1 The pharmacokinetics of diazepam following intravenous administration have been investigated in six normal volunteers and nine epileptic patients receiving chronic antiepileptic drug therapy. 2 After intravenous administration, serum diazepam levels declined biexponentially in all subjects. The elimination half-life was significantly shorter and the plasma clearance significantly higher in the patients than in the normal volunteers. 3 Serum N-desmethyldiazepam levels were higher and the time to peak serum concentration was earlier in the epileptic patients than in the controls. 4 It is suggested that the metabolism of diazepam is induced in patients treated with enzyme inducing antiepileptic drugs, although a protein binding interaction between valproic acid and diazepam may contribute to the higher plasma clearance in the epileptic patients taking sodium valproate.     

Novel approaches to anticonvulsant drug discovery

Introduction: The history of epilepsy dates back to 2000 BC. Yet, it was not until 1912 that the activity of the first antiepileptic, phenobarbital was discovered by accident. After this discovery, the next antiepileptic drugs to be discovered (phenytoin and primidone) were based on the phenobarbital's structure. Then, in 1960, carbamazepine was developed empirically, while in 1962, valproate demonstrated anticonvulsant activity against experimental seizures. The next antiepileptic drugs synthesized were either modifications of the existing drugs (such as oxcarbazepine and pregabalin) or completely novel chemical structures (lacosamide, perampanel and retigabine).

Areas covered: The present paper briefly refers to the history of epilepsy and development of antiepileptic drugs. Further, the paper provides a discussion on the antiepileptogenic effects of antiepileptic drugs in terms of the constant percentage of epileptic patients with refractory seizures. The authors also review the likely factors involved in the false refractoriness (such as through the use of caffeine-containing beverages and smoking). Finally, the authors consider future directions in the search of novel antiepileptic drugs.

Expert opinion: In spite of the considerable number of newer antiepileptic drugs, the number of drug-resistant epileptic patients remains unchanged. This may be rather an indication of the suitability of the currently available discovery procedures for effective antiepileptic drugs in the whole population of epileptic patients. The authors, however, believe that it is likely that models of mimic chronic epilepsy will help bridge the gaps and aid in the discovery of novel antiepileptic drugs – ones that can effectively modify the course of the disease.     

苯妥英钠预防白消安致癫痫发作失败病例分析

目的探讨白消安致癫痫的预防及治疗的应用及优化。方法通过对1例苯妥英钠预防白消安致癫痫发作失败的病例进行深入分析,从药学监护角度就白消安剂型选择、预防性抗癫痫治疗的必要性、起始抗癫痫治疗的时机和抗癫痫药物的选择等问题进行讨论。结果调研认为该患者预防性抗癫痫治疗的理由充分,但白消安口服剂型对其血药浓度的影响及苯妥英钠治疗不充分可能是导致患者癫痫发作的原因之一,苯妥英钠作为预防白消安所致的癫痫发作并不是唯一选择。结论临床药师对白消安/环磷酰胺预处理方案下抗癫痫治疗方案进行探讨及优化,为临床治疗提供细节的依据。     

Paracetamol disposition in normal subjects and in patients treated with antiepileptic drugs.

1 The serum concentration profile of paracetamol has been determined after administration of single 1000 mg intravenous and oral doses in six normal subjects and six epileptic patients on chronic antiepileptic drug therapy. The urinary excretion of free and conjugated paracetamol has also been determined. 2 Following intravenous administration, serum paracetamol concentration declined with first-order kinetics. Both elimination rate and total body clearance were higher in the epileptic patients, although in neither case was the difference statistically significant. 3 The oral bioavailability (mean +/- s.e. mean) was significantly lower in the epileptic patients than in the normal subjects (0.77 +/- 0.03 and 0.89 +/- 0.02 respectively, P less than 0.01), whereas the urinary excretion total (free+conjugated) paracetamol was almost identical in the two groups. 4 It is suggested that the lower bioavailability of paracetamol in the epileptic patients results from enhancement of first-pass metabolism, secondary to enzyme induction.     

Disposition of sodium valproate in epileptic patients.

1 Serum levels of valproic acid have been determined at fixed intervals after the administration of single oral and intravenous doses (800 mg) to six epileptic patients receiving chronic treatment with other antiepileptic drugs. 2 Serum levels declined monoexponentially shortly after the intravenous administration. Biological half-lives averaged 9.0 +/- 1.4 h (s.d.). Volumes of distribution were 0.175 +/- 0.025 l/kg. There was a statistically significant negative correlation between volumes of distribution and serum half-lives (P less than 0.005). 3 After oral doses serum levels rose rapidly to peak values within 0.5--2 h. Biological availability was 96 +/- 9%. 4 Comparison with a previous study performed according to the same protocol in healthy volunteers showed significantly increased volumes of distribution and rates of elimination in the patients. Total serum clearance was 85% higher in the patients as compared to the healthy subjects (P less than 0.001). Possible explanations for these findings are discussed.