苯妥英钠抗癫痫的血药浓度监测分析与药学研究

目的:探究分析苯妥英钠抗癫痫的血药浓度和合理用药效果。方法:选取前来某院检查的癫痫患者60例,监测分析苯妥英钠在癫痫患者临床运用的血药浓度、合理用药等方面的影响。结果:对60例癫痫患者运用苯妥英钠治疗,有效血药浓度为50～100μg/mL(35例),治疗总有效人数34例,占比97.14%(34/35)。当苯妥英钠的血药浓度高出或低于上述有效范围,则患者的不良反应发生情况升高,在癫痫患者临床中运用苯妥英钠,能够有效控制患者血药质量浓度,控制患者的不良反应(P<0.05);在患者临床中,18～60岁癫痫患者占比量大,用药后血药质量浓度有效范围人数为27例,有效血药浓度范围人数占比为60.00%,患者临床治疗效果显著(P<0.05)。结论:苯妥英钠的血药浓度与抗癫痫的效果关系紧密,有效血药浓度占比越高,患者的抗癫痫治疗效果越显著,临床可根据有效血药浓度值为患者制定个性化的用药方案,具有较高的临床应用价值。     

143例癫痫患者苯妥英钠血药浓度监测分析

目的分析癫痫患者苯妥英钠的血药浓度监测结果,为苯妥英钠的合理用药提供依据。方法采用高效液相色谱法测定癫痫患者苯妥英钠血药浓度,并观察其患者的症状、合并用药的情况。结果143例患者中,苯妥英钠血药浓度低于10μg.mL-1占36.36%,10~20μg.mL-1的占27.97%,血药浓度大于20μg.mL-1占35.66%。其中出现中毒反应的占10.49%。结论对长期使用苯妥英钠的患者进行血药浓度监测,可为临床医生制定个体化给药方案提供客观依据,对提高癫痫治疗的安全性、有效性有重要意义。     

苯妥英钠的血药浓度监测与临床疗效分析

目的对苯妥英钠进行临床疗效分析。方法我院821例癫痫患者进行血药浓度监测分析。结果821例患者中,中毒人数为257例无效56例。结论影响苯妥英钠的临床疗效因素很多,应用苯妥英钠时应当个体化,同时应严格进行血药浓度监测。     

111例抗癫痫药物血药浓度监测结果分析

目的 通过血药浓度监测了解苯妥英钠、卡马西平、苯巴比妥这3个抗癫痫药的血药浓度情况.方法 采用高效液相色谱法对111例分别口服苯妥英钠、卡马西平、苯巴比妥的患者进行血药浓度测定,并对结果进行分析、评价.结果 监测111例抗癫痫药血药浓度在有效血药浓度范围内的有57例,占51.4％,低于有效血药浓度范围30例,占27.0％,高于有效血药浓度范围的24例,占21.6％.结论 对于癫痫患者进行血药浓度监测,对临床及时调整用药方案,降低癫痫发作频率,减少药物不良反应具有重要意义.     

苯妥英钠血药浓度监测与个体差异

目的:通过对苯妥英钠血药浓度监测结果的分析,探讨苯妥英钠剂量与患者血药浓度以及临床疗效间的相互关系.方法:采用化学发光免疫分析法,对98例服用苯妥英钠的癫痫患者的血药浓度监测结果及临床疗效进行分析与评价.结果:苯妥英钠的有效剂量和中毒剂量与分别对应的血药浓度的个体差异均较大.结论:苯妥英钠治疗癫痫患者应重视血药浓度的监测,并应结合临床,着眼于个体化给药.     

临床药师参与1例抗癫痫药物致神经毒性患者的治疗

目的结合血药浓度监测及药物相互作用分析,为癫痫患者提供合理的治疗方案。方法临床药师参与1例发生神经毒性的癫痫患者药物治疗过程。通过血药浓度监测提示视物晃动、不能行走、视物重影、嗜睡和言语笨拙等症状为苯妥英钠中毒反应,建议暂停苯妥英钠,合理选择治疗方案。结果医师采纳临床药师建议,患者病情明显好转。结论血药浓度监测是提高抗癫痫药物治疗有效性和安全性的必要手段。临床药师参与癫痫药物治疗管理,进行正确的用药指导,保证用药规范性,避免不良反应发生。     

苯妥英钠血药浓度监测与个体化给药

用紫外法测定苯妥英钠血药浓度，报告了142例（次）的测定结果，介绍了监测用药个别典型病例。指出苯妥英钠的血药浓度监测，在癫痫治疗中具有重要的临床指导意义。     

苯妥英钠血药浓度34例测定分析

目的 通过对临床数例苯妥英钠血药浓度的监测,分析影响血药浓度的因素,为临床苯妥英钠的个体化给药提供参考.方法 采用高效液相色谱法测定了34例癫痫病人血清苯妥英钠浓度.结果 得临床血药浓度结果,并对影响血药浓度的因素进行分析.结论 苯妥英钠剂量与疗效关系因人而异,必要时应进行严密的血药物浓度监测.     

苯妥英钠抗癫痫血药浓度监测的结果分析

目的通过对苯妥英钠血药浓度监测结果的分析,了解浓度与疗效间的关系。方法选择我院2008年2月至2012年2月收治入院的经确诊的癫痫患者100例临床资料进行回顾性分析,采用化学发光免疫分析法对患者苯妥英钠血药浓度结果进行监测分析。结果 100例血药浓度测定的患者中,有效64例(64%),疗效不足30例(30%),无效6例(6%),中毒13例(13%)。结论苯妥英钠个体药代动力学参数差异大,治疗癫痫患者应重视血药浓度的监测,做到个体化给药。     

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.     

癫痫患者2种治疗药物浓度的监测及其临床意义

目的：监测治疗癫痫患者血清中苯妥英（ＰＨＴ）和卡马西平（ＣＢＺ）的浓度。方法：建立高效液相色谱法,测定住院和门诊７８例癫痫患者血药浓度。结果：其中服用苯妥英２３例,卡马西平５５例,低于治疗有效浓度分别有１４例和１９例,各占６０．８７％和３４．５５％,中毒浓度１例。结论：癫痫患者的治疗与苯妥英和卡马西平的用药水平有关,治疗剂量不能仅凭经验用药,有条件则应进行血药浓度监测,实行个体化给药。     

Control of epilepsy with a single daily dose of phenytoin sodium.

Fifty-three patients in an epileptic centre have been studied. All were receiving phenytoin and many were also receiving other antoconvulsant drugs. 2. Thirty-six patients took part in a three month cross over study. There was no significant change in the frequency of epileptic seizures or in the late morning serum concentration of phenytoin when the treatemtn was changed from two to three spaced doses of phenytoin sodium/day to a single dose at 12.00 hours. 3. Seventeen patients acted as a control group. They received phenytoin sodium as two or three spaced doses/day throughout the study. There was no significant change in the frequency of epileptic seizures or in the late morning serum concentration of phenytoin between the first and second three month periods of observation. 4. It is concluded that the total daily dose of phenytoin sodium may be given once daily without reduction of the anticonvulsant effect.     

546例丙戊酸钠血药浓度监测结果分析

目的促进丙戊酸钠的临床合理应用。方法采用荧光偏振免疫分析法测定546例年龄为3个月～87岁的癫痫患者服用丙戊酸钠的797例次稳态血药浓度,并对结果进行分析。结果412例次（51．69％）丙戊酸钠血药浓度在有效治疗范围（50。100μg／mL）内,64例次（8．03％）高于100μg／mL,321例次（40．28％）低于50μg／mL;不同年龄段的血药浓度有效治疗范围无明显差异;服用丙戊酸钠缓释片后有63．37％的血药浓度在有效治疗范围内,明显高于普通片（50．29％）;合用卡马西平、苯妥英钠时,可使丙戊酸钠血药浓度降低,且三者联合服用时更明显,而合用妥泰、R-氨酪酸、氯硝安定时,血药浓度均无明显变化。结论丙戊酸钠血药浓度个体差异大,且受药物间相互作用等多种因素的影响,因此在服药期间应适时监测血药浓度并及时调整剂量,以提高临床疗效、降低不良反应。     

3种抗癫痫药的血药浓度监测及个体化用药体会

目的 :为临床抗癫痫药的合理应用提供参考。方法 :采用荧光偏振免疫法对88例服用苯妥英钠、63例服用苯巴比妥和63例服用卡马西平的患者进行血药浓度监测242次 ,并提供个体化给药方案。结果 :癫痫患者对这3种抗癫痫药的敏感性个体差异很大。结论 :癫痫患者的个体化用药必须以血药浓度数据为依据 ,还需综合考虑其他方面的因素     

Steady-state serum levels of anticonvulsant drugs in Chinese epileptic patients living in Taiwan

Steady-state serum concentrations of phenytoin and phenobarbital were obtained in 70 epileptic patients in Taiwan and evaluated with respect to age, sex, and body weight. As demonstrated, the steady-state serum level of phenytoin is not affected by the age and sex of the patients or by phenobarbital used as a comedication. Thus, the main contributing factor influencing the steady-state serum concentration of phenytoin is the drug dosage. Among Chinese epileptic patients, the saturation of phenytoin metabolism occurs at the dosage of 4 mg/kg/day.     

Oxazepam pharmacokinetics in patients with epilepsy treated long-term with phenytoin alone or in combination with phenobarbitone

The pharmacokinetics and serum protein binding of oxazepam, a drug mainly eliminated by a single step glucuronidation reaction, were studied in nine epileptic patients treated long-term with phenytoin or phenytoin with phenobarbitone, and in nine healthy control subjects. Oxazepam elimination half-life was shorter and apparent oral clearance higher in treated patients than in age and sex matched control subjects. Serum bilirubin concentration was lower in treated patients. There was no significant correlation between serum bilirubin concentrations and oxazepam elimination. Serum alpha 1-acid glycoprotein concentration was higher in the treated patients than in the control group. Oxazepam was more than 93% bound to serum proteins, but the extent of binding was not significantly different between the two groups. These results show that oxazepam glucuronyl transferase activity is increased by treatment with phenytoin alone or in combination with phenobarbitone in epileptic patients.     

Effect of valproate on free plasma phenytoin concentrations.

The plasma protein binding of phenytoin was studied in nine epileptic patients before and during addition of sodium valproate to the drug therapy. The free phenytoin fraction in plasma was significantly greater during sodium valproate treatment. The mean free fraction rose from 0.135 +/- 0.019 (s.d.) to 0.182 +/- 0.030. Total plasma phenytoin concentration fell significantly from a range of 4.3-26.2 micrograms/ml to 3.4-19.8 micrograms/ml during sodium valproate treatment. Neither the free plasma concentration nor the saliva concentration of phenytoin was significantly altered by sodium valproate. No significant correlation was found between plasma valproic acid concentrations and the change in phenytoin binding. We conclude that valproic acid displaces phenytoin from plasma protein binding sites but does not inhibit its metabolism.     

Should we routinely measure free plasma phenytoin concentration?

The plasma protein binding of phenytoin was investigated in 56 epileptic patients attending the outpatient clinic. The free phenytoin fraction was measured by equilibrium dialysis at 37 degrees C and the total concentration by a homogenous enzyme immunoassay technique. The free fraction ranged from 0.123 to 0.177 (median 0.144, mean +/- s.d. = 0.145 +/- 0.12). Distribution was consistent with normality. Four of the patients were also taking sodium valproate. The median free fraction of phenytoin in these patients was 0.174, 21% higher than that of the total group (P less than 0.05). The total concentration of phenytoin varied from 0.3 to 29.4 micrograms/ml (median 12 micrograms/ml, mean +/- s.d. = 13.31 +/- 6.13 micrograms/ml) and the free fraction was not related to the total drug concentration. There was a highly significant relationship between free phenytoin concentration and total phenytoin concentration (r = 0.986, P less than 0.001). There appears to be very little variability in protein binding of phenytoin in epileptic patients and thus total plasma phenytoin concentration closely reflects the free (unbound) drug concentration. Routine estimation of free plasma phenytoin concentration is therefore unnecessary and should be reserved for those patients where alteration in binding is likely, e.g. renal or hepatic disease or where adverse effects occur at unexpectedly low total phenytoin concentrations.     

Evaluation of therapeutic drug level monitoring of phenobarbital, phenytoin and carbamazepine in Iranian epileptic patients

OBJECTIVE: The antiepileptic drugs phenobarbital, phenytoin and carbamazepine are widely used for the treatment of partial and tonic-clonic seizures. Large inter-individual differences in pharmacokinetics of these drugs, and the intermittent nature of epileptic attacks, increase the need for therapeutic drug level monitoring of these drugs. MATERIAL AND METHODS: In this study, data from the therapeutic drug monitoring of phenobarbital, carbamazepine and phenytoin in 328 epileptic patients were evaluated. Serum levels of drugs were determined in a University Department of Pharmacology by high-performance liquid chromatography. RESULTS: In this study, approximately 56% of patients were treated with 1; 30% with 2; and 14% with 3 antiepileptic drugs. In patients receiving 1 antiepileptic drug, the percentages treated with phenobarbital, carbamazepine and phenytoin were 41, 38 and 21%, respectively. In patients who received carbamazepine, serum levels in 40% of the patients were in the range of 4-8 microg/ml and more than in the range 4-12 microg/ml in 74% of the patients. In phenobarbital-treated patients, serum levels in 73% of the patients were in therapeutic range of 10-40 microg/ml, and about 44% of phenytoin-treated patients had serum levels in therapeutic range of 10-20 microg/ml. Approximately 50% of carbamazepine- and phenytoin-treated patients and approximately 70% of phenobarbital-treated patients were completely controlled. The frequency of concentrations within the therapeutic ranges decreased in patients using more than 1 antiepileptic drug. In patients who received both phenobarbital and sodium valproate, serum levels of phenobarbital were significantly (p < 0.05) greater than in patients who were taking this drug in combination with carbamazepine or phenytoin. CONCLUSION: Our results indicate that serum levels of antiepileptic drugs, and the percentage of patients with complete seizure control are comparable with results obtained in other populations in previous studies.