Mazure C M, Nelson J C, Jatlow P I, Kincare P, Bowers M B
Department of Psychiatry, Yale University School of Medicine, New Haven, Conn.
J Clin Psychiatry. 1990 Aug;51(8):330-4.
Serum perphenazine concentrations and early resolution of psychosis were examined to determine if blood level monitoring could be used to maximize drug efficacy while limiting extrapyramidal side effects (EPS). Sixty-six acutely psychotic inpatients were given perphenazine 0.5 mg/kg/day for 10 days, and their response was rated blind to blood level. Although 36 of 66 patients showed resolution of psychosis, neither perphenazine nor N-dealkylated perphenazine levels were related to global response or to Brief Psychiatric Rating Scale (BPRS) totals. Improvement in two individual BPRS items (hallucinations and conceptual disorganization) was related to serum perphenazine levels and suggestive of a lower therapeutic threshold of 0.8 ng/mL. Perphenazine level was not correlated with EPS; but benztropine, given only if required for serious EPS, was more likely to be used when perphenazine levels were elevated. The data suggest that higher perphenazine levels were no more effective than moderate levels but that higher levels may be associated with increased EPS; the data also suggest that individual symptoms rather than global response were associated with a lower therapeutic perphenazine threshold.
研究了奋乃静血清浓度与精神病症状的早期缓解情况，以确定血药浓度监测是否可用于在限制锥体外系副作用（EPS）的同时最大化药物疗效。66名急性精神病住院患者接受了为期10天、剂量为0.5mg/kg/天的奋乃静治疗，且在不知道血药浓度的情况下对其反应进行评分。虽然66名患者中有36名精神病症状得到缓解，但奋乃静及其N-去烷基化代谢产物的水平均与总体反应或简明精神病评定量表（BPRS）总分无关。BPRS的两个单项（幻觉和概念紊乱）的改善与血清奋乃静水平相关，提示较低的治疗阈值为0.8ng/mL。奋乃静水平与EPS无关；但仅在严重EPS需要时才使用的苯海索，在奋乃静水平升高时更有可能被使用。数据表明，较高的奋乃静水平并不比中等水平更有效，但较高水平可能与EPS增加有关；数据还表明，个体症状而非总体反应与较低的奋乃静治疗阈值相关。
