Ostapowicz A, Zejmo M, Wrześniewska J, Białecka M, Górnik W, Gawrońska-Szklarz B
Psychiatr Pol. 2000 Jul-Aug;34(4):595-605.
Modern pharmacotherapy is based on precise adjustment of a dosage schedule to individual requirements of patient. Therapeutic drug monitoring is a method that allows for a more effective treatment approach, especially in the case of a narrow therapeutic index of a drug. Tricyclic antidepressant drugs are characterised by narrow therapeutic index as well as relationship between serum drug concentration and side effects. It was demonstrated that interindividual variability of blood concentrations of tricyclic antidepressant drugs is related to genetic polymorphism of oxidating enzymes participating in metabolism of these drugs. The aim of the study was to estimate the impact of therapeutic drug monitoring of tricyclic antidepressant drugs as well as genotyping on efficacy and safety of endogenous depression therapy. The study included 9 patients with established diagnosis of endogenous depression. Blood serum concentrations of amitryptyline was measured by fluorescence polarisation immune assay (FPIA, Abbott system). Genotype of cytochrome P450 isoenzyme CYP2D6 was determined using PCR-RFLP method. It was demonstrated that monitoring therapy of tricyclic antidepressant drugs in combination with determination of the genotype seems to be more safe and effective. Monitoring therapy and genotyping may be less expensive than the costs of prolonged hospitalisation and risk of side effects.
现代药物治疗基于根据患者的个体需求精确调整给药方案。治疗药物监测是一种能实现更有效治疗方法的手段，尤其是在药物治疗指数较窄的情况下。三环类抗抑郁药具有治疗指数窄以及血清药物浓度与副作用之间存在关联的特点。已证实三环类抗抑郁药血药浓度的个体间差异与参与这些药物代谢的氧化酶的基因多态性有关。本研究的目的是评估三环类抗抑郁药的治疗药物监测以及基因分型对内源性抑郁症治疗的疗效和安全性的影响。该研究纳入了9例确诊为内源性抑郁症的患者。通过荧光偏振免疫分析（FPIA，雅培系统）测定血清阿米替林浓度。使用PCR-RFLP方法测定细胞色素P450同工酶CYP2D6的基因型。结果表明，三环类抗抑郁药的监测治疗与基因型测定相结合似乎更安全有效。监测治疗和基因分型的费用可能低于延长住院时间的费用和副作用风险。
