Kugelberg Fredrik C, Apelqvist Gustav, Wikell Cecilia, Bengtsson Finn
Department of Clinical Pharmacology, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
Basic Clin Pharmacol Toxicol. 2005 Sep;97(3):155-61. doi: 10.1111/j.1742-7843.2005.pto_97385.x.
Patients with chronic liver impairment often display symptoms of affective psychiatric nature where the choice for antidepressant treatment is rational. Since caution is recommended when these drugs are used in such patients, a dose reduction is usually performed. We have previously reported that a dose reduction to liver-impaired portacaval shunted rats has resulted in similar brain concentrations of venlafaxine as compared to sham-operated control rats that received a two times higher dose. The main aim of the present study was therefore to investigate if this "normalisation" in pharmacokinetics of the portacaval-shunted rats also was true for the pharmacodynamic response in terms of drug effect on spontaneous open-field behaviour. Thus, portacaval-shunted rats received a single reduced dose (5 mg/kg) of venlafaxine or saline, whereas sham-operated rats received either 10 mg/kg or saline. Thereafter, central and peripheral arena locomotor and rearing activities were recorded during 60 min. The venlafaxine-treated portacaval-shunted and sham rats displayed reduced and unchanged overall behavioural activities compared with corresponding controls, respectively. However, the ratios between centrally and peripherally performed behavioural activities were higher in the venlafaxine-treated sham rats, indicating an increase in central arena activity as compared to the sham-saline and portacaval-shunted rats. The present study indicates that, despite a 50% dose reduction, caution still is necessary when antidepressants are used in liver insufficient subjects. This study also shows the importance of detailed open-field behavioural studies in which both central and peripheral activities are recorded for measurement of open-field behavioural drug effects.
慢性肝功能损害患者常表现出情感性精神症状,此时选择抗抑郁药治疗是合理的。由于在这类患者中使用这些药物时建议谨慎,通常会进行剂量减少。我们之前报道过,与接受两倍高剂量的假手术对照大鼠相比,肝损害的门腔分流大鼠减少剂量后,脑内文拉法辛浓度相似。因此,本研究的主要目的是调查门腔分流大鼠药代动力学的这种“正常化”在药物对自发旷场行为的药效学反应方面是否也成立。于是,门腔分流大鼠接受单次减少剂量(5毫克/千克)的文拉法辛或生理盐水,而假手术大鼠接受10毫克/千克或生理盐水。此后,在60分钟内记录中央和外周旷场的运动和竖毛活动。与相应对照组相比,文拉法辛治疗的门腔分流大鼠和假手术大鼠的总体行为活动分别减少和未改变。然而,文拉法辛治疗的假手术大鼠中央和外周行为活动的比率更高,表明与假手术生理盐水组和门腔分流大鼠相比,中央旷场活动增加。本研究表明,尽管剂量减少了50%,在肝功能不全的受试者中使用抗抑郁药时仍需谨慎。本研究还显示了详细的旷场行为研究的重要性,其中记录中央和外周活动以测量旷场行为药物效应。