辣椒素对文拉法辛药动学影响研究

目的：考察辣椒素对文拉法辛及其活性代谢物O-去甲基文拉法辛体内药动学的影响。方法：选取10只健康SD大鼠，采用自身对照方法，考察单剂量给予盐酸文拉法辛（20.25 mg·kg^-1）（对照组）以及连续7 d灌胃辣椒素后再给予盐酸文拉法辛（实验组）的药动学差异。采用已验证的液相色谱-串联质谱法（LC-MS/MS）测定血浆中文拉法辛及O-去甲基文拉法辛的浓度，经DAS 3.2.4软件计算药动学参数，SPSS软件计算两组实验的差异是否具有显著性。结果：对照组和实验组大鼠血浆中文拉法辛的AUC_0-10、C_max、T_max、t_1/2分别为（780.81±709.76）μg·L^-1·h^-1和（1037.84±582.63）μg·L^-1·h^-1、（517.57±462.46）μg·L^-1和（876.64±301.79）μg·L^-1、（0.32±0.20）h和（0.25±0.09）h、（1.00±0.84）h和（0.89±0.18）h；O-去甲基文拉法辛的AUC_0-10、C_max、T_max、t_1/2分别为（163.60±77.93）μg·L^-1·h^-1和（240.41±62.69）μg·L^-1·h^-1、（96.83±46.51）μg·L^-1和（182.52±46.40）μg·L^-1、（0.46±0.30）h和（0.25±0.06）h、（1.19±0.32）h和（2.65±1.58）h；其中实验组的AUC_0-10、C_max均增加，差异具有显著性。结论：辣椒素增加文拉法辛的吸收，提高生物利用度，即能影响文拉法辛的体内药动学过程。     

影响文拉法辛血药浓度相关因素的研究进展

文拉法辛为苯乙胺类抗抑郁药,具有抗抑郁谱广、药物起效快、生物利用度高、安全耐受性高、对5-HT选择吸收抑制效果好等优点,在治疗重度抑郁、广泛性焦虑障碍和抑郁共病方面占有重要地位,但该药药动学过程个体差异较大,且其血药浓度受患者个体、药物相互作用和基因多态性等多方面因素影响,导致治疗效果不理想或治疗无效。该文通过检索PubMed、Medline、Embase、CENTRAL、PsycNET、中国生物医学文献数据库、CNKI、维普、万方等数据库,搜索建库至2022年12月文拉法辛治疗药物监测的相关文献,旨在对影响文拉法辛血药浓度的因素进行综述,为该药在临床应用中的安全、有效提供参考。     

文拉法辛治疗抑郁症的临床研究

目的：探讨文拉法辛治疗抑郁症的临床研究情况。方法：选取2012年12月～2014年1月我院收治的120例抑郁症患者作为研究对象,随机分为观察组60例和对照组60例。对照组给予阿米替林75mg/d治疗,观察组给予文拉法辛75mg/d治疗,治疗8周后比较治疗前后第1周、2周、4周、8周汉密尔顿抑郁量表（HAMD）5项评定疾病严重程度;采用不良反应量表（TESS）评定药物不良反应;采用生活质量综合评定问卷（WHOQOL-100）评定生活质量及临床疗效情况。结果：两组治疗后第1周、2周、4周、8周的抑郁情绪、精神焦虑、睡眠不深的HAMD总分及各因子项目分情况较治疗前明显降低（P＜0.05）。两组认知障碍项目在治疗后第2周、4周、8周评分较治疗前明显降低（P＜0.05）,两组体质量治疗后8周评分较治疗前明显降低（P＜0.05）,观察组治疗后第2周、4周、8周精神焦虑因子评分低于对照组（P＜0.05）,观察组治疗后第2周、4周睡眠不深因子评分低于对照组（P＜0.05）,观察组HAMD总分较对照组明显降低（P＜0.05）。观察组痊愈率为16.67%,总有效率为80.00%;对照组痊愈率为15.00%,总有效率为68.33%;观察组总有效率明显高于对照组,差异有统计学意义（P＜0.05）。两组患者治疗8周后WHOQOL-100总分及各因子分均较治疗前升高,且观察组在心理领域、生活领域、社会关系领域、环境领域评分均高于对照组,差异显著具有统计学意义（P＜0.05）。观察组不良反应发生率低于对照组,差异有统计学意义（P＜0.05）。结论：文拉法辛治疗抑郁症起效快,抗焦虑效果明显,安全性高,能更好地提高患者的生活质量。     

文拉法辛门诊治疗抑郁症的疗效

临床上我们时常碰到不少抑郁症患者由于各种原因不愿住院治疗。已有文献报道文拉法辛 (ven-lafaxine)治疗抑郁症有效且见效较快 [1～ 3] ,因此 ,在最近的 1 0 mo中 ,我们在门诊对国产文拉法辛治疗抑郁症进行了开放性的对照研究 ,旨在进一步了解该药临床疗效及其不良反应。1　材料与方法1 .1对象　本院门诊中符合中国精神疾病分类方案与诊断标准第二版修订本 (CCMD- 2 - R)中抑郁症诊断标准 ,且汉密尔顿抑郁量表 (hamilton depres-sion scole,HAMD) 1 7项总分≥ 1 8分者。入组前反复向患者及其家属说明疾病性质及治疗要求 ,并征得患者及…     

盐酸文拉法辛缓释片的制备及其家犬体内药动学初步研究

 　目的：研制盐酸文拉法辛(venlafaxine hydrochloride,VH)缓释片,并评价其家犬药动学特性及生物利用度。方法：以Kollidon SR为基本骨架材料制备缓释片芯,用Kollicoat SR 30D包衣混悬液包衣,采用单因素考察法优化VH缓释片。以RP-HPLC测定VH血药浓度,对6只家犬进行药动学和生物利用度初步研究。结果：VH缓释片优化处方中片芯骨架材料为Kollidon SR 80%,以Kollicoat SR 30D包衣混悬液包衣增重为1%时,具有良好的缓释特征;单剂量口服自制VH缓释片与市售VH缓释胶囊的AUC0~36 h分别为(1 107.25±202.85)和(1 172.54±276.05) ng?h?mL-1;Tmax为(7.2±0.8)和(6.7±0.8) h;Cmax为(106.57±19.40)和(102.00±34.00) ng?mL-1;缓释片的相对生物利用度为(96.04±13.20)%。结论：盐酸文拉法辛缓释片具有缓释特征,同市售缓释胶囊生物等效。     

中国男性健康志愿者口服去甲文拉法辛缓释片对映体选择性药动学研究

建立手性LC-MS/MS法同时测定人血浆中去甲文拉法辛(desvenlafaxine,DVS)对映异构体,并应用于其在中国人体内的立体选择性药动学研究。本法采用d6-去甲文拉法辛作内标,分析柱为Astec ChirobioticTM V手性色谱柱(150 mm×4.6 mm,5μm)。R-去甲文拉法辛、S-去甲文拉法辛在0.500~150 ng·m L-1内线性均良好(r2>0.99)。本方法成功应用于12名健康受试者空腹口服琥珀酸去甲文拉法辛缓释片100 mg后人体立体选择性药动学研究。结果表明在中国健康人体内去甲文拉法辛两对映异构体药动学参数基本相似,而各个对映体的Cmax和AUC参数均是文献报道黑人和白人受试者相应参数的1.5倍左右。     

盐酸文拉法辛缓释片人体药动学和生物等效性研究

目的建立测定文拉法辛血浆药物浓度的HPLC荧光检测法,研究盐酸文拉法辛缓释片在人体的药动学和评价生物等效性.方法48例青年健康志愿受试者(单次给药24例,多次给药24例),分别单次和多次交叉口服文拉法辛参比制剂75 mg和受试制剂75 mg,采用HPLC法测定给药后不同时间点血浆中文拉法辛和O-去甲文拉法辛经时血药浓度,采用DAS 2.0进行药动学参数计算.结果单次和多次口服盐酸文拉法辛缓释片的血药浓度-时间曲线符合一室开放模型.单次口服受试制剂和参比制剂后文拉法辛的Tmax分别为(6.5±1.9)与(6.3±1.4)h,t1/2分别为(11.6±4.9)与(11.7±4.3)h,AUC0～1分别为(1 840.0±1 153.1)和(1 956.O±1 201.2)μg·h·L-1;O-去甲文拉法辛的Tmax分别为(12.0±6.0)与(10.3±6.1)h,t1/2分别为(18.9±4.8)与(20.3±6.2)h,AUG0-t分别为(1 356.8±344.1)和(1 382.8±287.3)μg·h·L-1;文拉法辛和O-去甲文拉法辛的生物利用度分别为(94.3±13.3)%和(99.3±20.4)%.多次口服受试制剂和参比制剂6 d后文拉法辛的AUCss分别为(1 488.9±863.3)和(1 630.7±962.2)μg·h·L-1,Tmax分别为(7.0±1.6)与(6.7±1.8)h,DF分别为(114.63±27.05)和(110.94±24.25);O-去甲文拉法辛的AUCss分别为(528.3±220.6)和(568.3±251.1)μg·h·L-1,Tmax分别为(7.7±2.1)与(7.3±1.9)h,DF分别为(70.12±21.63)和(71.67±24.27);文拉法辛和O-去甲文拉法辛的生物利用度分别为(93.2±17.7)%和(95.9±17.0)%.结论经方差分析和t检验,证明两制剂生物等效.     

文拉法辛治疗抑郁症开放性研究探析

目的探讨文拉法辛治疗抑郁症临床研究效果。方法 38例抑郁症患者,均应用文拉法辛进行治疗,疗程持续8周,分析其汉密尔顿抑郁量表（HAMD）与汉密尔顿焦虑量表（HAMA）评分变化情况。结果经治疗,患者总有效率为89.5%,HAMD和HAMA评分治疗后均明显降低,治疗各个时段对比,差异均有统计学意义（P〈0.05）。结论文拉法辛可以明显降低患者抑郁症状,经治疗,大部分抑郁症患者均可以冶愈,且具有良好耐受性及依从性。     

盐酸文拉法辛胶囊在健康人体内的药动学和生物等效性

建立了LC-MS/MS法测定人血浆中的文拉法辛,研究了24例男性健康受试者双周期、交叉、随机、单剂量口服盐酸文拉法辛胶囊50 mg后的药动学和相对生物利用度.受试与参比制剂的主要药动学参数分别为:c_(max)(71.1±29.9)和(71.2±26.6)ng/m1.t_(max)(2.31±0.67)和(2.31±0.75)h:t_(1/2)(4.68±1.30)和(4.83±1.39)h;AUC_(0→24)(534.7±334.6)和(543.9±370.3)h·ng·ml~(-1),相对生物利用度为(101.8±18.3)%,两种制剂具有生物等效性.     

文拉法辛治疗抑郁症40例

目的观察文拉法辛治疗抑郁症的临床疗效与不良反应。方法将81例抑郁症患者随机分为两组，治疗组40例给予文拉法辛胶囊口服，开始剂量为75 mg·d^-1，剂量范围为75～225 mg·d^-1，平均（35±15） mg·d^-1；对照组41例给予氟西汀胶囊口服，40 mg·d^-1。两组均治疗6周。采用汉密尔顿抑郁量表、汉密尔顿焦虑量表评定疗效，采用不良反应量表评定不良反应。结果治疗组有效率为95.0%，不良反应少而轻。对照组有效率为87.8%，两组疗效和不良反应均差异无显著性。结论文拉法辛治疗抑郁症安全有效，值得临床推广使用。     

氯氮平在中国精神分裂症人群的群体药物动力学研究

本研究旨在考察口服氯氮平 (clozapine) 在中国精神分裂症患者中的群体药物动力学特征, 探讨各项动力学参数与人口统计学因素及CYP1A2酶基因多态性的关系, 通过建立群体药物动力学模型指导临床个体化给药。研究中采集了临床服用氯氮平的183例精神分裂症患者的626份稳态血样本资料, 随机分组为建模组 (168例) 和外部验证组 (15例)。用非线性混合效应模型 (NONMEM) 程序中的一级评估法 (first-order estimation, FO) 对建模组的数据进行分析, 估算清除率 (CL/F)、表观分布容积 (V/F) 和吸收速率常数 (K_a) 的群体值, 并且定量评价人口统计学指标和CYP1A2酶基因型因素对药物动力学参数的影响。建模中单室一级吸收和消除模型能够较好地拟合数据。最终模型包含了经体表面积归一化的单日剂量 (DBSA) 和吸烟 (SMOK) 因素对CL/F的影响。CL/F (非吸烟组)、V/F和K_a的群体典型值分别为28.5 L·h⁻¹ (5.05%)、1 290 L (16.7%) 和2.26 h⁻¹ (fixed), 相应的个体间变异分别为42.2%和10.0%。研究发现吸烟组的清除率有所上升。观测值与预测值之间的残留误差SD为45.8 μg·L⁻¹。     

中国患者异丙酚群体药代动力学(英文)

目的:用NONMEN程序分析中国患者群体药代动力学,并定量研究性别、年龄和体重对异丙酚药代参数的影响。方法:研究了76例择期手术的患者(男37例、女39例、年 龄19-77岁、体重39-86kg),共收集1459个血液标本。用NONMEN方法分析清除率和分布容积的个体间变异以及年龄、体重和性别的影响。结果:可用三室模型模拟异丙酚的药代动力学参数。体重可影响异丙酚的中央室、浅外周室和深外周室的清除率以及中央室的分布容积,而浅外周室和深外周室的分布容积保持不变。体重60kg的成人的上述药代参数的估计值分别为:1.56L/min、0.737L/min、0.360L/min、12.1L、43L、213L。老人随年龄的增大而清除率和中央室的分布容积减少。结论:中国人的异丙酚的药代动力学可用标准三室模型描述,年龄和体重可影响模型参数。因此根据患者的个体药代参数可改善靶控输注的精密度。     

Population pharmacokinetics of digoxin in pediatric patients

Digoxin pharmacokinetics were studied in a pediatric population with an age range of 6 days to 1 year using the population pharmacokinetic approach. Digoxin data were analyzed by mixed-effects modeling according to a one-compartment steady-state pharmacokinetic model using NONMEM software. The final model selected for the population prediction of digoxin clearance in pediatric patients was as follows: [equation: see text] Individual empirical Bayesian estimates were generated on the basis of the population estimates and were used to correlate the optimum dose of digoxin and patient age according to the following equation: [equation: see text] This equation and its derived nomogram may be used for the initial dosing of digoxin in children aged between 0 and 1 year. The use of this nomogram in routine monitoring requires further pharmacokinetic and clinical validation.     

Population pharmacokinetics of ceftazidime in burn patients

AIM: The aim of this study was to characterize, via a population pharmacokinetic approach, the pharmacokinetics of ceftazidime in burn patients who were not in the acute post-injury phase. METHODS: The development of the pharmacokinetic model was based on data from therapeutic drug monitoring (41 patients, 94 samples). The estimation of population pharmacokinetic parameters and the selection of covariates (age, gender, body weight, size of burn and creatinine plasma concentration) that could affect the pharmacokinetics were performed with a nonlinear mixed effect modelling method. RESULTS: No relationship between covariates and the pharmacokinetic parameters was established with the exception of an inverse-linear relationship between creatinine plasma concentration and ceftazidime total clearance. The total clearance of ceftazidime was 2.72 l h-1[coefficient variation (CV) = 56.3%] and the distribution volume of the central compartment was 0.28 l kg-1 (CV = 13.2%) The transfer rate constants (k12, k 21) between the central and peripheral compartments were 0.06718 h-1 (CV = 87.2%) and 0.001823 h-1 (CV = 82.7%), respectively. From these parameters, the total ceftazidime volume of distribution (10.64 l kg-1) was calculated. CONCLUSION: The population parameters were different from those obtained in a previous study performed in fewer patients and in the early period after burn injury. In our study, the lower ceftazidime clearance could be explained by the relative decrease in ceftazidime elimination in relation to the burn area, and the higher ceftazidime volume of distribution in the presence of interstitial oedema, which could act as a reservoir from which ceftazidime returns slowly to the circulation.     

Population pharmacokinetics of lamotrigine in elderly patients

Lamotrigine is being used more frequently in elderly patients. Dosing of lamotrigine in elderly patients is based largely on studies from younger adults and not evidence-based data from elderly patients. The goal of this study is to determine the pharmacokinetic parameters, such as clearance, and the factors that have a significant effect on these parameters to provide evidence-based information that can be used to dose elderly patients taking lamotrigine. Lamotrigine plasma concentrations from 148 elderly patients (aged 59-92 years) were used to develop a population pharmacokinetic model. Data were analyzed using NONMEM. Model evaluation was performed using the bootstrap approach and predictive check. The results showed that the blood urea nitrogen/serum creatinine ratio, weight, and phenytoin use significantly affect apparent clearance of lamotrigine. These results show that clinicians may need to take into account these covariates when dosing lamotrigine in this population.     

Population pharmacokinetics of ciprofloxacin in pediatric patients

The objective of this study was to characterize ciprofloxacin population pharmacokinetics in pediatric patients. A total of 150 pediatric patients (including 28 patients with cystic fibrosis [CF], ages 0.27-16.9 years) received ciprofloxacin by the oral and/or intravenous routes. Population pharmacokinetic analyses were performed with NONMEN software. Exponential error models were used to describe the interindividual variance in pharmacokinetic parameters, and the residual error model included both proportional and additive components. Based on principles of allometry, the patient's body weight was used as a covariate, along with appropriate allometric exponents, in the construction of the base model. Model building was accomplished by a stepwise forward inclusion procedure, and the final model was evaluated by multiple techniques, including bootstrap, leverage analysis, and cross-validation. With body weight included in the model (two compartments with first-order absorption), ciprofloxacin clearance was influenced by age, and the absorption rate constant was altered in CF patients. The final model is summarized as follows: CL(L/h) = 30.3 x (WT/70)0.75 x (1 + 0.045 [AGE-2.5]), VC(L) = 56.7 x (WT/70)1.0, VP(L) = 89.8 x (WT/70)1.0, Q(L/h) = 37.5 x (WT/70)0.75, Ka (1/h) = 1.27 x (1 + [-0.611 x CF]), absorption lag time = 0.35 hours, and bioavailability fraction = 61.1%, where WT and AGE are the patient's body weight (kg) and age (years), respectively, and the variable CF equals 1 for CF patients and 0 for non-CF patients. The interpatient variability in pharmacokinetic parameters (percentage coefficient of variation [%CV]) ranged from 22.5% to 49.8%. The residual variabilities (%CV) for the oral and intravenous data were 40% and 27%, respectively. The shared additive residual variance component was small (SD = 0.04 mg/L). Model evaluation by the different methods indicated that the final model was robust and parameter estimates were precise. A small difference (< 6%) was noted when the patient's age was not used in dose calculation. Therefore, in routine clinical use, for pediatric patients older than 3 months, ciprofloxacin dose may be calculated solely based on body weight.     

成年患者替考拉宁群体药动学研究

目的：构建中国成年患者替考拉宁（teicoplanin,TEC）群体药动学（population pharmacokinetics,PPK）模型,探讨TEC药动学参数的影响因素。方法：收集患者的用药信息、血药总浓度、性别、年龄、血清肌酐水平等信息,采用非线性混合效应模型法（nonlinear mixed effect model,NONMEM）建立替考拉宁PPK模型。用图形法、非参数自举法（bootstrap）、正态化预测分布误差法（normalized predictive distribution error,NPDE）进行模型评价。结果：共收集111例成年患者的149个替考拉宁血浆总浓度数据,建立了替考拉宁的一房室PPK模型：CL （L·h^-1）=1.26×（eGFR/82）^0.431,V（L）=83.1,协变量分析显示肌酐清除率（CKD-EPI公式）是影响替考拉宁清除率的重要因素,未发现影响替考拉宁表观分布容积的因素。经验证,最终模型具有良好的拟合优度、稳健率及预测性能。结论：临床可根据患者肌酐清除率（CKD-EPI公式）制定个体化给药方案。     

Population pharmacokinetics of tenofovir in AIDS patients

The interindividual variability of tenofovir pharmacokinetics in HIV+ patients is quite large, but the sources of variability are incompletely understood. Intraindividual variability has not been characterized, although it may have an impact on efficacy and therapeutic drug monitoring. The aims of the study were to estimate intraindividual variability of tenofovir clearance and to assess interactions with associated antiviral drugs. Tenofovir concentrations (median 2; range, 1-5) were measured in 175 patients during several dosing intervals. Covariates and dosing regimen of associated antiretroviral drugs were recorded prospectively. The data were analyzed by a population approach. The final model was a 2-compartment model with first-order absorption rate. The elimination clearance was found to be related to the ratio of body weight to serum creatinine. Among the 15 drugs coadministered, no interaction on tenofovir kinetics was significant. The global variability of CL/F, after accounting for variability to variation of body weight and serum creatinine, was about 50%, with 20% due to interindividual variability and 30% due to interoccasion variability. In a few patients, clearance (and AUC) could vary by a factor of 2 between occasions. The interoccasion variability was not related to the delay between occasions. In the context of drug monitoring, for a given patient, the dose should not be adapted unless the variation of concentration between 2 occasions is large, or the 24-hour trough concentration at steady state is lower than 12 microg/L.     

Population pharmacokinetics of digoxin in Korean patients

AIM: Digoxin possesses a narrow therapeutic index and shows a large inter-patient pharmacokinetic variability. The purpose of this study was to develop a population model for the pharmacokinetics of digoxin in Korean patients. METHODS: Plasma concentrations of digoxin after multiple administration at varying dosing schedules in Korean patients were used for population modeling. Data analysis was performed with the P-Pharm software. The data were best fitted by a one-compartment model. The effect of demographic and clinical factors like sex, age, weight, disease state, and renal function on the pharmacokinetic parameters of digoxin was investigated. RESULTS: The study indicated that the clearance of digoxin was influenced by creatinine clearance, while body weight and creatinine clearance were the covariates for its volume of distribution. The population mean estimates for CL and V were 4.4 l/h and 535 l, respectively. Absorption rate constant was lower in females and in the presence of concomitant drug treatment. CONCLUSION: A population pharmacokinetic model for the digoxin pharmacokinetics in a section of Korean patients was developed. The relationships between the pharmacokinetic parameters and the demographic data and the patient-specific covariates were established.