Van Putten T, Marder S R, Wirshing W C, Aravagiri M, Chabert N
Veterans Affairs Medical Center, Los Angeles, CA 90073.
Schizophr Bull. 1991;17(2):197-216. doi: 10.1093/schbul/17.2.197.
There is enormous variation in plasma levels of most neuroleptics in patients on the same dose. Much of the past research on the relation between plasma levels of antipsychotic drugs and clinical change, however, has been difficult to interpret. It does appear that decreased bioavailability, at least in public institutions, is rarely the cause of treatment failure. Aberrantly low plasma levels are more likely due to surreptitious noncompliance or drug interactions with enzyme inducers such as carbamazepine. Therapeutic plasma level ranges, in which good antipsychotic effect occurs without undue side effects, have been tentatively identified for perphenazine, haloperidol, fluphenazine, and chlorpromazine. The extent to which aberrantly high plasma levels are associated with inferior antipsychotic response is unclear. Antipsychotic plasma levels may be most useful when the distinction between side effects and worsening psychosis is unclear. The utility of high neuroleptic plasma levels in the treatment-resistant patient is unclear.
服用相同剂量药物的患者，大多数抗精神病药物的血浆水平存在巨大差异。然而，过去许多关于抗精神病药物血浆水平与临床变化关系的研究很难解释。至少在公共机构中，生物利用度降低似乎很少是治疗失败的原因。血浆水平异常低更可能是由于偷偷不遵医嘱或药物与酶诱导剂（如卡马西平）相互作用所致。对于奋乃静、氟哌啶醇、氟奋乃静和氯丙嗪，已初步确定了能产生良好抗精神病效果且无过度副作用的治疗性血浆水平范围。血浆水平异常高与抗精神病反应较差之间的关联程度尚不清楚。当副作用与精神病恶化之间的区别不明确时，抗精神病药物的血浆水平可能最有用。高抗精神病药物血浆水平在难治性患者治疗中的效用尚不清楚。
