本文選題：拉莫三嗪 + 左乙拉西坦　； 參考：《中國藥房》2017年08期

【摘要】：目的:了解妊娠期婦女新型抗癲癇藥拉莫三嗪(LTG)、左乙拉西坦(LEV)、托吡酯(TPM)和奧卡西平(OXC)的藥物濃度監(jiān)測的研究進(jìn)展。方法:查閱近年來國內(nèi)外相關(guān)文獻(xiàn),就LTG、LEV、TPM和OXC的藥物濃度監(jiān)測的研究進(jìn)行歸納和總結(jié)。結(jié)果與結(jié)論:LTG、LEV、TPM和OXC在妊娠期的代謝率增加,血藥濃度顯著下降,部分患者癲癇發(fā)作頻率增加,產(chǎn)后血藥濃度迅速恢復(fù)至正常水平,但上述4種藥物的具體變化情況存在差異,且個體差異顯著。LTG、LEV、TPM和OXC在妊娠期血藥濃度的下降可能與葡糖醛酸化作用增強和腎清除率增加相關(guān),但顯著的個體差異導(dǎo)致不能提前預(yù)測和預(yù)防。妊娠期血藥濃度的下降不等于癲癇發(fā)作頻率的增加,規(guī)律的藥物濃度監(jiān)測給劑量調(diào)整提供了證據(jù)支持。雖然仍缺乏LTG、LEV、TPM和OXC大范圍適用的妊娠期有效的血藥濃度推薦范圍,仍建議在妊娠前獲得癲癇患者血藥濃度基線水平作為參考,確定個體化的有效血藥濃度范圍,妊娠各階段至少各進(jìn)行1次治療藥物的濃度監(jiān)測,若癲癇發(fā)作增加則應(yīng)及時測定血藥濃度并調(diào)整劑量;產(chǎn)后1~2周進(jìn)行治療藥物的濃度監(jiān)測,逐漸減量恢復(fù)至基線水平。
[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.
【作者單位】： 中國藥科大學(xué)基礎(chǔ)醫(yī)學(xué)與臨床藥學(xué)學(xué)院;四川省人民醫(yī)院藥學(xué)部;
【分類號】：R969.3

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